.. 'DOCUMENT RHUMB) CG 014 561 ED 199 536 41,
AUTROR Trent, Curtis: And Others TITLE The Influence of in Educational Intervention Module on Death and Dying on Death Anxiety/ Life Satisfaction and Locus of Control Among Middle Agtd and Older Adults in North Carolina. Summary and Workshop Guide.
INSTITUTION . North Carolina State Univ., Raleigh. 9PONS AGENCY Worth Carolina State Unit., Raleigh. Dept. of Adult andCoimunity Coll. Education. 4 PUB DAT°E Jan 90 NOTE 90p.: Sponsored in part by the NRTA-AARP. Andrus Foundation.
2DPS PRICE MF01/PC04 Plus Postage.- abESCRIPTORS \ *Anxiety: *Attitude Change: *Death:Intervention: *Locus of Control: Middle Aged Adults: Older Adults: *Program Effectiveness: Program Evaluation: Training Methods iDENTIF(E4 *Life Satisfaption: *North Carolina
ABSTRACT . The research findings of many.thanatologistslave broulht an awareness to the general public that the study ofdeath and dying is an appropriate and instructional teed for manypeople. The attitudes of middle aged and older adults regardingdeath anxiety, life satisfaction: and .locus of control were examined to determine whether adults would change their beliefs after participation in a 12-hour educational intervention module on death, and dying. Results indicated that as lifesatisfaction increased, death anxiety decreased. Respondents in poor health expressed signifigantly more death anxiety than respondents irvgood or
excelleit health. Subjects with higher levels of internal control . registered higher life satisfaction. Data collected 7..fter, workshop participation showed that sublects ekperienced a significant decrease in death anxiety. (The leader's guide for the workshop and a list of,* supplementary Materials are also included.) (Author/HLM)
**3011300****************************11W****WW*******************###*# * Reproductions supplied by EDRS are the best that can be made '* * frnm the oniginal document. * *X, Fr% Lt1 C7 THE INFLUENCE OF AN EDUCATIONAL INTERVENTiONMODULE ON DEATH AND DyING
, ON DEATH ANXIETY, LIFE SATISFACTION, AND UOCUS OF CONTROL
AMONG MIDDLE AGED AND OLDER ADULTS
IN NORTH CAROLINA
by
Curtis Trent Professor and 'Rate Leader of Extension Training North Carolina State University
J. Conrad Glass, Jr. Associate Professor, Adult and Community College4Education North Carolina State University
and
Ann YMcGee Research Assistant Department of Adult and Community College Education North Carolina State Uhiversity
U S DEPARTMENT OF MEL "PERMISSION TO REPRODUCE THIS EDUCATION & WELFARE MAtERIAL HAS BEEN GRANTED BY NATIONAL INSTITUTE OF EDUCATION THis DocumE NT HA5 BE EN LRE PRO. DuCED EXACTLY AS RECEIvED FRONT THE PERSON OR ORGANIZAIIDN ORIGIN. ATING IT POINTS OF VIEW OR OPINIONS STATED DO NOT NECESSARILY REPRE- SENT OFFICIAL NATIONAL !NISI ITuTE OF . C. TO THE EDUCATIONAL RESOURCES E P051 flON OR POL ICY 2 INFORMATION CENTER (ERIC)."
Supported. by:
The NRTA-AARP.Andrus Foundation and the , 10 Department of Adult and Community College Education tr1 North Carolina State University
CD January, 1980 ABSTRACT
THE INFLUENCE OF AN EDUCATIONAL INTERVENTION MODULE
ON DEATH AND DYING ON DEATH ANXIETY, LIFE -.....
SATISFACTION,AND'LOCUSOFC6NTROL
AMONG MORI AGED. AND OLDER
ADULTS IN NORTH CAROLINA
by.
Curtis.Trent, J. Conrad Glass, Jr., and Ann Y. McGee
le primary purpose of the study was to determine whether middle
\ aged and older adults' attitudes regarding death anxiety, li*fe satis-
s' factiontand locus of control could ba changed significantly through
0 participting.in a 12-hour educational intervention module on dea
.indAying. ,A second purpose was to determine the extent to which
certain personal and situational characteristics of respondents were
associated with pretest levels of death anxiety, life satisfactiien,
andlodus f control.
'The sample consisted of 207 middie aged and older adults from
various sections of.the State of North Carolina. The experimental
group numbered 94 and 113 people constitoted the control group. A
special effort Was made to insure representativeness in the control
group as compared to the experimental group. Special attention was
givea to such participant characteristics as age, sex, education,
income, health, race and marital status. Participation was voluntary.
The studyemployed the pretest4-treatment4-.posttest destgn.
The experimental group participdted ina series of six two-hour
workshops entitled "Death-LThe Fulfillment of Life," designed by the
researchers. The control group.received no instruction but completed
the.pretest and posttest. 3 "'An adaptation of Templer's Death Anxiety Scale, Neugarten,
Havighürst, and Tobin's Life Satisfactjon Scale, and Rotter's ocus
of Control Scale were administered to all participants inthe,study
ar. pretests and posttests Statistical techniques employed ilcluded:
Pearsonproduct-moment correlation coefficient, least squarks means
analYsis, stepwise regression, and'the t-te§t.
Analysis of the data revealed significant relationship) between
respondents' pretest levels of death anxiety, lifesatisfac4ion,and
locus of control and many of the variables examined. Life;satisfac-
tion and health were significantly related to pretat levelsof death
anxiety. As life satisfaction increased, death anxiety de:Creased.
Respondents who considered theii" health "poor" registeredOgnificantly
greater death anxiety than those who consider$Oheirheaith "good"
or "excellent." Those who thought mole frequently about death
registered higher death apxiety lhan those who ttought lessfrequently
about it,.Respondents who were fearful or depressed,thd.se'who felt
uncomfortable about .talking with others about the otherperson's
terenal illness, and those who.were afraid to die had significantly
higher death anxiety than those on the other end of thecontinuum.
"Fear of dying" accounted for 42.9,percentsof the variationin
pretest death anxiety scores.
Four variables were found to be significantly related to pretest
, ievels of life satisfaction (locus of control, death anxiety,
frequency of thoughts about death,and,aWareness of one's own mortal-
ity). Respondents with higher levels of internal control registered
higher life satisfaction. Those With lower death anxiety had higher
life satisfaction. Those who thought least frequently about dying
4 bad higher life satisfaction and those who responded mure p tively
to their feelings regarding their own mortality registered higher
life sutisfaction.
Life satisfaction and family income were the only two variables
significanth$ related to pretest locus of control. Those with high
life satisfaction had high internal control scores. Although the
relationship between family income and locus of control was signifi-
cant, no particular patterR emerged.
The major thrust of the study was to deter6ine whether the
educational intervention module could effect changes in death aoxiety,
life satisfaction,and locus of control. The t-test revealed that no
significant changes occureed in levels,of life satisfaction and locus
of conteol. However, there was a significant decrease in death 411 anxiety among participants in the workshop and no change in.the con- .
trol group. Two respondent characteristics were significantly related
IMP to the thange'in death anxiety--"fearof'dying" and "religious
denomination." It was concluded that the educational intervention
module did have an impact upon. the level ofdeath anxiety within the
workshop group hut.other factors also Accounted for some qf the
variance in change scores.
ir ACKNOWLEDGEMENTS
,. Appreciation is expressed to the NRTA/AARP* Andrus Foundation for the finahcial-support for this research project.
Gratitude is.expressed to the following cooperating organizationsand Institutions for their assistanc in sponsoring the workshops:
Cary Baptist Churt
. Durham Technical Institute Friend& Home. Maryfield Nursing Home North Carolina State University
Randolph Technical Institute . St. James United Methodist Church Southeastern Community College Wayne Community College North Cfrolina Agricultural Extension Service Western. Carolina University
Appreciation is also extended to Harry Foley, Susan L.Harmuth, Sarah Jones, Libby Knott, Jean LeFrancois, H. L. Salisbury,and Joyce Wyatt for , of their invaluhble contribution in implementing theEducational Intervention I . Module and administering the questionnaires at theirrespective institutions.
The 207 adults who voluntarily served as researchsubjects in this experi- . ment are particularly due recognition. 0 Hospice, Inc., of North Carolina contributed brochuresfor the work- shops for which appreciation is expressed.
Consultation with Suzanne Gordon, Department ofStatiitics, North Caro- lina State University, on statistics and programmingprocedures deserves recognition.
Ackriowledgement is expreised for the assistance rendered by Becky Griffith, Selma McEntire, Brenda Warren, and LoisMiller who shared in typing of the project material and numerous tasksrelated to project imple- mentation and complegin.
'The artistic creation Of the project logo, by Dr. William L. Gragg, also deserves recognition.
A:special note of gratitude is expressed toRobert Jackson, who served as Research Assistant duringthe early stages of the project, for his con- tribution to the review of literatilre, research designand.conduoting of two of the workshops.
*Nationalletired Teachers Association/American Association for Retired Persons SUMMARY AND CONCLUSIONS "
Purpose
The primary purpose of this study was to determinewheiher
middle aged and older adults' attitudes regarding death anxiety,
life satisfactimandlocus of control could be thanged significantly
through participating in a 12-hour educational interventio module
on death and dying. .A second pgrpose was to determine the extent to.
which certain personal and situational characteristics of respondents
were associated with pretest levels bf death anxiety, life satisfac-
tionsand locut of control.
More specifically, the study addrissed the following research
questions:
1. To what extent are selected,personal and situational charic-
*teristics Of respondents related to their pretest levels of
dee6 anxiety, life satisfactionpand locus of control?
2. Can middle aged and older adults' attitudes regarding death
anx)ety, life satisfaction and locus of control be changed
significantly through participating in a 12-hour workshop_
on death and dying?
Background and Need for the Stu'dy
The subject of 'ideath and dying" has become less a taboo topic
due in part to the research and public Aiscustions OcKubler-Ross
(1969), Kastenbaum and Aisenberg (1979), Green and Irish (1971),
Kalish (1963), and many others. These thanatologists haveprodUced
impressive research findings and have brought to the attention of the -0/ 4 2
general public an awareness that the study of death and dying is an
appropriate and instrumental need for many people.
The study of death has been a-part of all societies and a major
subject of study for theologiani, philesophers, psychologists, sociol-.
ogists, and physicians. 'The 20th century ha; brouga tremendous
strides, in lifesaving and life-maintaining technologies. We are
7v living longer than ever and we are preventing disabling diseases from
attacking us with more proficien0 than ever before. However, there
seems to be a corresponding increase in many people's inability to
cope with the death experience. The denying.of one's own inevitable
death seems pervasiVe in our society--a defense mechanisM that'appears
7 to be,causing more anxiety than comfort (KUbler-Ross, 1969; Hinton, ,
.1973).
Death is a'biological and existential fact of life that affects
`le every human being. According to,Rebert Atchley (1972),' middle'age-is
the time when most people cOme to grips with the fact that death is
real, and not just something that happens to someone else..Gail
Sheehy,(1974, p. 10) describes the feeling she had when she suddenly
realized that she was facing her own death.as "something.alien,horn-
ble, unspeakable but undeniable . . . my ,owndeath." She believes.that
each ot us stumbles upon this issue in midlife and that we Must leirn
to live with it. It is no easy task to accept this reality,'and
Sheehy (p. 10) States, "We try to flee the task ofincorpoiatingour
own shortcomings and destructiveness, as well as the world's destruc-
tive °side. Rather than accept the unacceptable spooks, we try to
drive them aiay by resorting to the coping techniques that have
worked before." 3
a.. I* Koller,(1968,,p. 107) recognizes that "Certainly one of the most
difficult problems in ltving is to come to grips with the inevitabil- OP
ity of one's own demise.-- In this mental exercise individuals deyelop
various ways-oriurntng away from their involvement in life. Each
settles upon some pattern that will enable him to be functional
despite the certainty of eventual loss'of his conscious self. Perhaps
no otherpatteim reflects.more df the personality organization than
the manner.in which a person approaches:this own death."
Research on.the personal and situational variables related to
.death anxiety have not yet produced clea2tut findings. Rather, there
appears to be a series cif contradictoryconctd'sions based.on such
factors as age,:residence, life Satisfaction, locus of control, sex,
4 health, age of -death of parents and kin, religion, marital status,
income, education, and fear of deat.h. . Research Proeedures
The sample consisted of 207 middle aged and older adults from
various sections cf the State pf North Carolina. The experimental
group numbered 94 and 113 people'tomprised the control group. A
special effort was made to insure representativeness in the experi- .
mental aid control groups On such participant cnaracteristics as age,
sex, education, income, health, race, and marital status. ,Partici-
pation was voluntary. % 'The study employed the pretest+treatment+posttest research design.
The experimental group participated in a series Of six two-hour work-
sho,ps entitled "Death - The Fulfillment of Life." The control group
receivedno instruction but completed the pretest and posttest. 4
The workshops were conducted by the resea hth and several leaders
trained by the researchers. .0 The workshops offered participants an opportunity to learn about
many facets of the "death expPrience," fnteract with other partici-
pants relative to their own feelings about death and dying, and
provided experiences and exposure to positive options for later life.
The learning experiences consisted of lecture7discussions, audio-
visual presentations, group discusOnns, case studies, and sensitivity
exercises. .P
A Pretests and posttests were administered to the experimental and
control groups. Scales used to measure levels ofdeath.anxietY,
lifesatisfaction,and locus of control were:an adaptation of 0 A Templer's Death Anxiety Scale, NeugartenrHavighurst, and Tobin's
Life Satisfaction Scalesand Rotter's I-E Scale.
10 -The major statistical techniques employed were: Pearson
product-moment correlation coefficient, least squai'es means
. analysis, stepwise regression,ana the t-test. 0. 0
Results and ConClirsions
The pretest mean scores indicated that,as a group, the partici-
., pants in.this study were somewhat low in death anxiety, relatively
high in llfe satisfaction, and relatively,high in their sense of in-
ternal control. It should also be noted that, generally, the partici-
pants well mostly white persons who had above average education, good.4,
health, and were from the middle to high income bracket. ..Due to the
heavy concentration of persong possessing these latter characteristics,
one may need to be cautious as he.or. she'attempts.to generalize the
results of this study to other groups of persons. Jo Life satisfaction and health were two variables'whichaPpeared
to be significantly related to death anxiety. As life satisiaction
increased, there seemed to be a decrease in death 'arikiety. This was a contrary to previous research (Bell and Batterson, 1979; Nelson,1974)
which had indicated that persons with high life satisfacttonexhibited
higher death anxiety. It juit may be that persons who are satisfied
with life do have.a sense that their lives have meaning and purpose--il
Erikson's terms, they haye ego 4integrityLand, therefore, theyCan
face the ultimate that life has to offer--death--without a sense of
fear. They do not have to fear death, for they can feel that.their
being here is worthwhile and satisfying. AnOther explanation for
the relationship between death anxiety and life satisfactioncould be
that persons who are satisfied with life are so busy enjoying life
that they just do not have time or do not 'take time to worry about
death. Their attention is so centered upon enjoying the life they are
living ioday that death and the anxiety surrounding it just do not .
impinge upon their consciousness.
As participants' health was viewed as teing-progressively poor,
death anxiety increased. The earlier research regarding health and
death anxiety reported conflicting results. The'finding of this work
is consistent with the research of Christ (1961) and Rhudick and
Dibner (1961), but is inconsistent with the work of Bell and Batterson
(1979)., Persons who see themselves as having poor health are probably more conscious of the fact of death, and, therefore,they,tend to be
more anxious about death.
Locus of control, age, sex, religiosity, race, religious denomina-
tion, education, family income, marital status, and occupation did not
appear to be related to death anxiety. IV! 6 // Four responsestoAlUestionspertaining to attitudes about death
were significantly related tp death anxiety: , (0 The more frequently persons thought about dying the higher was their death anxiety.
(2) Persons who were "fearful" or "depressed" when they thought about dying had the highest anxiety, while those who felt "resolved to accomplish something in my life" or who felt "pleasure in being alive" had lower death anxiety.
(3) Persons who had a lower death anxiety felt more comfortable in talking with a close individual about that individual's terminal illness than did persons who had high death anxiety.
(4) Those whoewere afraid to die had a higher death anxiety
score than those who were not afraid to die. . .
41. %The variables seudied in this research project accounted for 69.8
percent of the variation in the"death anxiety scores. The question
"I am not at all afraid to'die" accounted for the greatest amount of
wiation (42.9 percent) in death anxiety scores.
Of the respondentcharacteristics, only two appeared to be relat-
ed to life satisfaCtion--lOtus of control and death anxiety.The
'more individuals felt'that they controlled their oun lives, the more
satisfied they were with life. This finding is consistent with what
was expectedbased upon'the -literature review (Palmore and Luikart,
1972; 'Went, Glass and Jackson, 1978). As death anxiety decreased,
c- life satisfaction tended toOncrease. This latter finding was expect-
ed based upon the earlier discussions regarding life satisfaction and
death anxiety.
Health, education1 family income, occupation, sex, race,age,
religious denomination, religiosity, and marital status appeared to -
have no slogniftcant relationship to life satisfaction.
12 .V' 4.
7
Two responses to questions pertainfng to.death were significantly
related to life satisfaction.A. Gene:ply, those persons who thought
less frequently about death appeared to be more satisfied with life.
The one exception to the pattern was that those who "frequently"
thought about death :had'a ilightly higher life satisfaction pearl score
than those who "occasionally" ihought abouthdeath. Persons who were
able,to respOnd more positively-to the question, "When I think of
dying or when circumstances make me aware of my own mortality, I feel
. . .," had higher life satisfaction mean scores than those who
'responded negatively.
The qu,estion relating to whether or not one was afiAaid to die was
not significantly related to life Satisfaction.
Approximately 47 percent of the variation in lffe satfsfaction
scores were accounted for by the variables utilized in the analysis;
hoviever, no one variable peared to account for a substantial amount
of the variation. Further study is needed-in this area.
Life satisfaction and family incpme were the only variables which
-seemed to be related to locus of.control. In the previous discussion,
whem life satisfaction was the dependent variable, a relationship was
found between locus of control and life satisfaction. It was expected
that there would be a relationship between the two variables when
locus of control was the dependent variable. The more satisfied
persons.were, the more those individuals felt that their lives were
internally controlled.
141-46 family incomewas related to locus of control, it is diffA-
cult tp explain the relationship. There does not appear to be any
clear pqtecp regarding level of income and whether or not one feels
13 8
his or her life is internally or externally controlled. Most earlier
studies (Trent, Glass and Jackson, 1978; Kreps, 1971; Neugarten 0 and Maddox1978; Schultz, 1974) had indicated that persons who had
'higher incomeslended to feel that they were more internally controlled
than those who had lower incomes; though there was one study (Nehrke,
BellUCci and Gabriel, 1978) which had indicated.the opposite relation-
ship might.be true. The present study only adds to the conflicting
situation regarding relationship of family income to locus of control.
No significant relationship was found between locuA of contrOl
and death anxiety, religiosity, education, sex, race, age, religious
denomination, health, marital status, occupation or any of the ques-
tions about death used in this study. The variables analyzed in this
project accounted for 36.2 percent of the variation, but no one varia-
ble contributed a substantial amount to the variation.
The primary emphasis of the research project was to determine
whether middle aged and older adults' attitudes of death anxiety could
be changed significantly through participating in a 12-hour intervention
module (workshop) on death and dying. The results demonstrated that
death anxiety could, indeed, be decreased a small, but significant,
amount through participatirg in the workshop. There was no signifi-
cant change in death anXiety within thescontrol group. It could be
concluOed that the intervention module (workshop) as developed and
conducted, would be a useful educational activity for reducing death
anxiety in adult groups with timilar characteristics to those partici-
,pating in the study.
A second, but lesVr, emphasis of the research was to determine
whether middle 'aged and older adults' attitudes of life satisfaction 14 9
k ) could be changed significantly through parttcipating in the instruc-
li e tion module on death and dying. It was anticipated that there would
be.ah increase in life satisfaction amórig the workshop participants . and no change in the control group. Although participants in the workshop showed a slight,increase in life'satisfaction from pretest to posttest, the change was not significant at the level chosen for rejecting the hypotheses. There was a slight but smaller nonsignifi- cant increase in life satisfaction within the control group. It could be concluded that life satisfaction, as measured by the scale used in this study, may have been affecteddifferentially by the subject matter addressed in the instruction module.Also, the length of the workshop was perhaps too short and interaction too limited to make a significant 4mpact on such a broad concept as lifesatisfaction.
It was concluded that the instructionmodule was not effective in influencing'a significant increase in life satisfaction among the workshop participants.
A third and also lesser emphasis of the research was to determine whether middle aged and older adults' attitudes of locus of control could be changed significantly through*participating in the interven- tion module on death and dying. It wasmexpected that participants in the workshop would showan increase in internal control even though research presents conflicting evidence. The workshop.was designed to bolster maintenance and coping skills in one important area of life.
The results of the study did not support the conceptual framework established for the stud... There was no changeinmean internal- external locus of control scores from pretest to pos test among the participants.in the workshop. The non-participa s showed aslight,'
1 5 10
but 'nonsignificant, decrease in internal control. It was noted that
both groups--experimental and contr61--exhibited very high levels of
internal control (12.559 and 12.423, respectively) prior to the work-
shop. The fact that the pretest scores were so high may.have limited
the potential for ;further increase in internal control. It was con-
cluded that the instruction module had no significant impact upon
participants' locus.of -control.
The last seCtion of the data analysis focused on the relationships
between changes in death anxiety and personal and situational charac-
teristics of respondents participating in the workshop.As there were
no significant changes lin life satisfaction or locus of control from
pretest to posttest, it was decided to examine the data to determine
what factors other than the workshop bxperIences were related to the.
decrease in death anxiety within the experimental group.
The least squares MainS aniTytis showed-that 50 percent of the
variance in difference scores in the experimental group were accounted
for by the variables in the linear mcidel. Only two respondent charac-
teristics were significantly related to the decrease in death
anxiety--"fear of dying" and "religious.denomination." Two additional
re'spoodent characteristics--"easeone felt in talking with someone
else about their terminal illness" and "marital status"--approached
a significantrelationsfilp with change in death anxiety. I Both factors
should be explored further in future Studies. It-was concluded that 4 factors other than the workshop accounted for much of the cpange in- death anxiety within the workshop group, but the workshopftself did
have a decide:i impact upon change in death anxiety.
16 11
IMPOCATIONS
The results of this study have important implications-for educa-
tors; institutions, organizations, and state anifederal government
agenciesconCernedwith enhancing the quality of the adult life. The' major focus ofothis study was to see if death anxiety could be reduced
through a planned educational experience. This study has demonstraied
the effectiveness of a particular unit on death and dying in changing
death anxiety in vcOnteer adult audienco. While further evidence
needs to.be gathered regarding its effectivenesswitWdifferentgroups
of adults, it would seem that this workshop, in its present fonn,
could beused with similar groups throughoUt the country to lower
death anxiety. It would seem that the methodology and materials could
be used with some confidence in other situations until the workshop
has been tested in those situations..
The fact that the leader's guide for this workskop was designed
for lay leaders implies that this workshop can be planned and conduct-
ed without the leader being an "expert" on the subject of death and
dying. This should make the workshop more readtly accessible to
varibus adult group. It is true that lay.leaders could become
involved in topics which might be beyond their 'ability to handle; hoW-
, ever; it is believed that the detailed instructions and the suggested
-resources provide a framework which should keep the learning'experiences within a Imanageable"emotional level for most Oults. The nature of
.the leader's guide ihotild mean that the workshop could be used exten-
sively by many groups in North Carolina and the U.S.A. The short time
required°for the workshop should enhance its attractiveness to poten-
-tial audiences. . 1*- 17 12
It should be of interest toeducatorsthat attitudes toward
death (death anxiety) can be changed significantly over a relatively
short pertod of time'(six weeks) throuigh educational experiences
designed speCifically to change 'death anxiety. This-ihange.seemed,to
occur in,bne course of rudy Over a six-week period. It is exciting
to iMagine what might happen if death education could become a part,of
all.indiiduals' leaening experiences throughout their lives.
The approach used in this Study his potential for adaptation ,to 4 other subject areas where attitudechange is a major objective. If
attitudes toward death anxiety can be lowered, perhaps other attitudes
can be,changed in a positive direction through similar means.
f- The findings"-óf this stridy should contribute to the body of
knowledge.relatinvto cOntinuing education for.adults and to attitudes
4 I I.
. and attitude change. The fact.that the variables identified.in this .
study, accounted for 69.8 percent of the variance in death anxiety
scores should be of'yalue to researchers. In additiqn, the research
methodology of this study might serve as a guide for future research
involved with attitude change.
The profile data of the participants in this study-should provide
some clues-to adult educators, as to the kinds of peetons who volunteer
for learning experiences relating to death and dying. Such an analy-
sis should suggest prime target groups for.death education. In addi-
.:; tion, a study of the profile should al's() provide clues to the kinds
of persons who may not attend death education experiences on a volun-
teer basis. The:latter study might provide a starting point for
educators to consider alternative delivery systems for death education. ep.
1 13 .
It may be that the greatest value to be derivedfrom a workshop
on death and dying.is that such a learning experiencebrings peorile Ps
to the point of Confronting the inevitability oftheir'oWn death.
Perhaps, over time, such an experience will aid individuals in re-
thin g the meaning and purpose oftheir own' lives. A positive resolu-
. tion of this.process, perhaps, can help persons move toward self-
fulfillment', greater happiness inlifelrandmaybe equip them to assist
oth6s'in the process.of- facing the fact of detti.
.4
1
19
.4 14
RECOMMENDATIONS Is
'Based ,on the findings of this study, it is recommended that the
leader's guide used in this study be produced in a.format and in
quantities which can be .readily available for widespread use. It is
further recommended that the findings of this study, along with.the' ,
availability of this unit, be widely circulated to_persons"tuCh as .
, directors of continuing education_in c011eges and universities,
technical institutes-and-community collegesv denominational religious
leaders, persons concerned with aging,in the Agricultural Extenston
Services in the various states, admi.niitrars of retirement complexes
and nursing homes, program directors'of44korganizillonsas'
hospices; etc.
It.is recommended that further Tesearqb on attitOdes toWard .
fleath anddying be conducted and educational programs be developed
and evaluated as to their effectiveness,in changing attitudes among
I` the various age groupings in society. The following researcn projects
are recommended:
1. Conduct this same study with other mr representative . samplei, of adults.
Conduct a longitudinal stud; to determine whether attitudes
doncernift death and dying Change as persons move through
the life span andto determine what variables may be re-
lated to,different attitudes at different,pointsolf the
life span..
3. Adapt this workshop material for use with children and youth
in the public schools and conduct research to determine if
z)o
/%; 15
4 their attitudes can be changed through participation in the
lwning experiences..
4. Build in a follow-up death anxiety.measurement (after, four
to six months) into futurestudieion attitude change to
\determine if.the change in death anxiety persists over time. \
5. Conduct a study which measures tlie effectiveness of two ort,
more educational'imethods in changing death anxiety.
Conduct a study to determine,Whdt, if any, influence the
death anxiety attitudes of the workshop leader have on the
,amount ofchange occurring within the vprkshop panicipants.
7. Conduct a study to determine what, if any, effect a workshop
on death anddyini would haveupon theittitudes and rat- performance of health care professionals who daily relate
.to dying persons.
41
9 1 0
16. N.
-4;
L
r
Leader's Guide for Workshop:
Death -*The Fulfillment of Life
-
22 17
Workshop
DEATH - THE FULFILLMENT OF LIFE
Purpose .
The purposes of the workshop are to help participants become better able to discuss the topic of death; t3 provide them an oppor- tunity to examine their own attitudes toward death and to develop a philosophy of living.
Outline
Session I:,
The-Meaning of Life and Death
AiMs: To help participants: (1) Understand some of the feelings and attitudes regarding death and dying prevalent in today's society. 011. (2) Examine their own feelings and attitudes toward death and dying. (3) Understand that the meaning life has for an individual is related to the.meaning death holds for that individual.
'-'Session. II:. if Customs Surrounding Death
Aims: To help participants: (1) Recognize the universal human need for _symbolic rituals in dealing with death. (2) Understand some of the motives Underlying cultural Oractices surrOunding death in the United States.' (3) Understand that the customs and rituals surrounding death reveal an individual's or society's.philosophy aboutdeath. (4) Becomemore open in their willingness to discuss the topicof death through the sharing of feelings with other participants.
Session III:
Sta es of Death and D in. and Alternative Care
Aims: To help participants: (11 Understand the various stages of the dying process'and realize that these stages are experienced by most people. (2) Become aware of various caregivers involied in the dying process. (3) Reflect on how alternative care systems might help in the accept- ance of death. fi 18
. Session IV:
0 Handling Grief
Aims: To help participants: I Understand the meaning of grief. '2 Understandthe stages of WO. 3 Examine their own feelings about grief.
141 Become aware of roles that caregivers.may assume with those in
' grief. J.
.Session V:
atoices about Life and Death
Aims: To help participants: (1) Understand their choices in aetermining how, when and where they wish to spend their last days or years: (2) Examine their own 'attitudes and feelings about euthanasia. (3) Become familiar with the "Dying Person's Bill of Rights" and the "Living Will." (4) Beco6e familiar with the hospice movement and its development.,
Session VI:
Decisions in Life about Death
. Aims: To help participanti: a (1) Become more aware of many of the details ilvolved in the dying process::, estate planning, funeral arrangements and familyaffairs. (2) gpderstand that through a fulfillment of life, death can become a fulfilling experience. (3) Reach a closure between their past'and prey it feelings about death and facilitate plans for the future.
4
a
Az- ME.
19 ocT,ct
SESSION i
How Do You View Death?.
Aim:
.To help particjpant5/
(1) Understand some of the feelingsand4ttitudesregarding death and dying prevalent in today's soCiety.)
(2) Examine their own feeliqgs and attitudes regarding death and dying.
(3) Understand that the meaning life has for an individual is rdlated ta the meaning death holds for that indiVidual.
Resources Needed:
"Workshop Outline" Materials for name tags--construction paper or 34x 5 cards, felt markers, masking tape or straight pins Cassette tape player Cassette tape with songs about death Information Stieet 1,."Songs abowt Death" Information-Sheet 2, "Death Ceremonies" Information Sheet 3,,"Philosophies of Death" InfoPmation Sheet 4, "Bibliography of Readings" Questionnaires about death and dying Filmstrip, "Walk.in the World for Me" Filinstrip projector, Screen ,03 Manila envelope
Room Arrangement:
If,possible, the room should,be arranged with chairs around tables or in a semi-circle, in Order to encourage discussion. The filmstrip projector and screen should be set and ready for showing.
Teaching Plans for Session:
A. Name Tags (Do this as persons arrive, prior to the announced starting time.)
Prepare name tags out of construction paper or 3 x 5 cards. Have persons print their names on the name tag with a felt marker. Ask them to print large enough for others to read at a distance. Use masking tape or.straight pins to stick the.tags to the petson.
3 25 20
The leader should help the l'irst two persons who arrive to prepare their name tags,. Ask those tifo people to help the next two. pegple to get a name 'tag. Urge them to use that time to get'acquainted with those persbng, Aen those two could help the next two, and so on. This "each one help one" tech:. pique should help the group, members to begiji to-relate AD a person or.two. It will give individuals soiMething to do as they enter and it :,houlci. begin the proc.ess of creating a comfortable climate for learning.
Introduction (30 Minutes)
At the announced starting time fOr the session, the leader might get the attention of the group and introduce the 'six- session study in this manner:
"For six sessions we will be studying the topic of death and dying*While this is not an issue that most of us like to talk about, it is an area which all of-us must face during some time in our lives--whether it be our death orthat of a person close to us. We will have an opportunity to learn ubout many different facets of. the 'death experience.' We" will be able to interact with others about our feelings and experiences. We will look at some positive alternatives'which should help us as we have to deal with death And dying.
"It is important to mention, at this point, that there is the possibility that some very sensitive emotions may arise.during the come of this study. For some persons these emotionsmiy be too Oinful to deal with. Unfortunately, we are npt equipped to deal with persons who would have extreme diffi- culty in handling their emotions about death. If you feel un- - comfortable about participating in any activity, please feel free to leave at any'ttme.
",Thisserie't Ofworkshops was developed at North Carolina State University as an attempt to help adults become better informed about death and be better able to cope with it.. In an effort to determine if these workshopsareieffective, we need your help filling out some forms. These are not tests, but are a miens by which we can see if the learniq,experi- ences have any effect on what we think about deathand dying. These form3 will give us an understanding of what individuals feel about life and death and of various factors.related to life and death. Some parts of these forms will be idminis- tere4 again at the end of the six sessions and the results will be compared with the first session to seA what changes have occurred.
"PA the end of the learning sessions, we need to be able to identify each person's forms and keep them together. You can 0 facilitate this process if you will put your sdcial security
26 21
number or phone number on th, first page. We will ask you to do the same at the end of the.course. There will never be any attempt to try to identify any of this information with a parttpular name. This is only a way to keep the proper in- formation grouped together; Your participation in this part of the project will help give some insights into the effective- ness of this workshop. You will help strengthen the worksnop and help coritribute to others who may participate in a similar workshop in the future."
As the individuals Pand in their finished papers, place the forms in a:large ma.illa envelope. Give each student as q. he/she finishes the paper a copy of Information Sheet 1, "Songs about Death.",
C. Music Activity (15 minutes)
"Music is very revealing. It reflects the pleasures, anxie- ties>.concerns, problems, and doubts of people. Listen to the following songs about death and follow the words on the informa- tion sheet. While you are listening, think about these ques- tions:
17. 'How is death pictured in these songs? 2. Do you agree with the images of death portrayed here? -Why Vv. why not?"
As d total group, listen to the songs. Following the presen- tation of the songs, divide the total group into smaller groups of three per group. Restate the two questions and ask them to discuss the questions.
D. Discussion'Activity (go minutes)
After about ten minutes in the small groups, come together as a total group to discuss the questions. Spend a brief amount of time on question one, but spend a greater amount of time with the second question.The purpose of this portion of the session is to help the group members to verbalize and examine their own thoughts and feelings regarding death and dying.
For many individuals, this may be the'first time they have . tried to put their thoughts into words for other persons. Some 'other questions which may help this discussion are:
1. How dp you view death? What is the meaningofdeath for you? 2. What do,you think has most influenced your views about death? 3. Why do.you think people fear death? 4. What do you fear most about death?
You may not be able to deal with ill of these questions be- cause of time limitations. Use those whicOseem most appropriate within the time constraints you face. 22
E. Death Philosophy (15 minutes).
To make thetrarisitionfrom the previous discussion to this portion of the sessiong_the following stateMent might be helpful:
"For the last few minutes we have really been discussing what mighObe called our own philosolihies regarding death. Dr. Venus Bluestein, who teaches death education courses at the University.of Chicago, has a very brief statement regarding her own philosophy about death. I wonder how you react to her thoughts: v". own ortentation is, to put it quite briefly, that death education helps one to liVe this life more fully and meaning- fully. When one accepts that 'he will die, that his life is finite, that he cannot choose how and when he will die, but that he can choose how he will live--be gaps a different perspective on life; relationships take on4a new meaning; one develops a different set of priorities; one constantly questions--how do I wish to spend my life?What are the really important things?"
4* After the group has had a brief time to initially react to the statement, you might pose the following questions:
(1) Do attitudes about death have an effect on how one views
life? .
t (2) Do attitudes about life haye an effect on how one views death?
Very little time needs to be spenon discussion of these questions. They are really more for reflection than discus- sion.
F. Show the Filmstrip, "Walk in the World for Me" (30 minutes). Introduce the filmstrip to'the group. The following'state- ments might be used: 'In this filmstrip Doris Lund, author of the book Eric, offers us a powerful experience with death, honestly meCiii4.endured. Through her spoken commentary and a sensitive photo-essay, Mrs. Lund recreates her son Eric's five-year struggle against leukemia. As you view this film- strip, keep these qgestions in mind:
1. What attitudes about death are presented here? 2. How are they.similar or different from those we've discussed earlier?e 3. How do the philosophy and values presented here speak to Ou and your own values?"
If time allows, spend some time discussing these questions at the conclusion of the filmstrip. If not, dismiss the group until the next meeting. 23
Handouts for Next Session
Give participants Information Sheet 2, "DeathCeremonies, and Information Sheet 3, "Philosophies of Death."Ask them to read both ty next session.
Also hand out Information Sheet 4, "Bibliography ofReadings." oust mention that this bibjlography contains readingswhich they might find helpful if they wish todo further study.
Hand out "Workshop Outline." Say to the group: "This outline gives an overview of the aims of the workshop and thetopics to be covered.".
H. Topic for Next Session
Tell the participants that the topic for the nexcSession. will be "Customs Surrounding Death." 24'
INFORMATION SHEET 1
Songs about Death
"Mbrtality" Composed by Daniel Reed From the album: The New'Golden Ring, "Five Days Singing," Vol. 2 Death, like an overflowing stream
. Sweeps us aWay. Our life's a dream, An empty tale,
A morning flower . Cut down and withered in an hour.
"Ain't NoGrave Can Hold My Body Down"
. Sung byJoe Hickerson Album: "Drive Dull Care Away," Vol. 1 Ain't no grave can hold my bodydawn, my body down.
41 Ain't no grave can hold my bodydown, my body down. When that first trumpet sounds, gettin' up, and walkin'arOund. Ain't no grave can hold my bodydown, my body down.
Well I've heard 'bout a place called heaven Where the streets 'are' paved with gold. WellI never been to heaven But, oh Lord, I've been told. When I 'rive_that throne of grace I believe he'll 1-Pbint my-soul_A pThee Ain't no grave can hold my body dbWn,-inybody down.
"0 Death, Where Is Thy Sting?" From: "The Messiah" by G. F. Hindel By: London Symphony Orchestra and Chorus 0 death, 0 death, where, where is thy sting? 0 death, where is'thy sting?
0 grave, where is thy victory?0 gravel . 0 death, 0 death, where, where is thy sting? where,. 0 grave, where is thy victory? 0 death, where is thy stiny? 0 grave, 0 grave, where is thy victory? 0 grave, where is thy victory? The sting of death is sin, the sting of death is sin, and the strength of sin is the law, the sting of death is sin, and the strength of sin is the law. "BOry Me Not on the Lone Prairie" Sung by:.Heddy West Album: "Forty Great.Folk;ongs".(Radio Shack) Oh, bury me not, on .the lone prairie. These words came low, and mournfully. From the pallid lips, of a youth who lay On his dying couch, at the close of'day.
He'd wasted his life, 'til aroundhiPorow The shades of death, are a gathering 0"; He'd thoUght of his home, and ,his deat'Oiend nigh. As.the.cowboys gathered, to see him die.
Oh, bury me not, on the lone prairie.- 'Where the- wild coyotes, will howl'Yer me. Where the. wild coyotes, and,the winds sport freek \ Bury me not, on the lone prairie.
I've often times wished, to be buried when I die, In a littte church yard, on a green hillside, Close to my Old home, there let me be. < Bury me not, on.this lone prairie.
Little does it matter, so I've been.told A body's laid, when a heart goes cold. Grant, grant as a bdon to me. Bury me not on the lone prairie.
His eyes they closed, and his voice fell there. They'd taken no heed, to his dying prayer.
In a lonely grave just six by 'three, ' They buried him there, or the lone prairie.
Oh bury me not,,on the lone prairie. These words come low, and mournfully. From the pallid lips, bf a youth who lay On his dying couch, at the close of day.
"And When I Die" ay: Blood, Sweat, and Tears, Columbia Records I'm not scared.of dying, And I don't:really care. If it's peace you find in dying, Well, then let the time be near.
If it's peace you find in dying, And if dyling time is near, Just bundle up my coffin, Cause it's cold way down there.
(coniinued)
31 .1%
, 26
e.
"And When I Die"'(continued)
I hear that it's cold way down there. Yeah, crazy.cold way down there. And when I die, And_when I'm gone, There'll be one child born, in this world, To carry ono.To-carry on.
Now troubles are many. They'ee as deep as a well. I can swear there ain't no heaven;
But I pray there ain't no hell. .
Swear there ain't no,heaven, 'And I pray there ain't no hell. But I'll never know by living, Coly by dying will.tell.
Yes,on)yhy dying,will tell. Yeah, only my dying will tell.
And when I die, And when I'm gone, There'll be one child born, in this world, To carry on, To carry on. Yeah. Yeah.
Give me my freedoM, For as long a'sI be. AllI ask of living,. Is to have no chains on me.
AllI ask of living, . It to have no chains on me. And allI ask of dYing, Is to go naturally.
Oh, I'm going to go naturally. Mere I go. Hay. Hay. Hay. *M. Here comes the devil. Right behind. Ny ve00 Look out children! Here he comes, Here he comes. Hey.
Don't want to go by the devil: Don't want to go by a demon. Don't want:to go by Satan. .Don't want to die uneasy.
... . ,/ )41tst let me go naturally.. \ nd when I die,
, And Mien I'm gone, There'll be one child born, in aworTIV To carry on, To carry on. Yeah: Yeah. it
27
\ INFORMATION SHEET 2 S.
DEATHCEREMONIES*
"The Kates
The Kotas are a people who live in seven small villages which are interspersed among the villages of their neighbors on a high plateau, the-Nilgiri, Hills, in South India. The height and inaccessibility of the plateau formerly isolated the tribal peoples who lived on it from the main cur'rentit30 Indian civilization.
The. Kotas observe two funeral aremonies: the first, called the "Green Funeral," takes place shortly after a death and it is then that the body is cremated; the 'second, called the "Dry Funeral," is held once a year (or once. in two Years) for all the deaths thathave occurred since the last Dry Funeral was celebrated. The terms are an analogy to a cut plint. At the first funeral, the loss is green and fresh in the mind; at the second, it is dried out, sere.
At the first funeral, a bit of skull bone is taken erom'Oe ashts of the pyre and reverently cached awaY until the second funeral. The DrY Funeral extends over eleven days and comes to a climax when each relic from the year's deaths is carried off to the cremation ground *5. and, after complex ritual acts, the relics are recrematod. The first
funeral is attended by the close relatives and friends 6f the deceased. . The second funeral is a grand occasiou, attencled by people from all the Kota villages and by non-Kotas as well. pr)t The emphasis of the funeral ritual is much more on speeding the departure of the spirit from this world than it is on the "Motherland" beyond. Kotas are not much interested in the other world and have ooly sketchy ideas about it. They are quite precise about the purification which the spirit and the surviving kin must undergo in order thatthe spirit may depart for guod.
6 . Among the Kotas, as among many of the peoples of India, contact with death is considered to be deeply polluting.A polluted person is debarred from normal social relations until he has been purified by a proper and protracted ritual. The spirit of the dead person, too, is polluted in leaving the body, and the dual funeral rites purify the spirit so that it may take up proper relations in the afterworlo.
Or
From Mandelbaum, David G., "Social Uses of,Funeral Rites." . In Herman Feifel, The Meaning of Death. New York: McGraw-Hill Book Co., 1959.
11, 28
etween the time of 'the body's last breath and the climactic end of the Dry Funeral, the lingering spirit is dangerous to men, especial-
_ ly tq the deceaced's closest kin. The climax comes when a pot is smashed, at the proper ritual Juncture, in the cremation ground beyond the village..At that signal all who have attended the ceremony --that is to sayomost of the villagers and many visitors--run back to
the village without looking behirld them. The living go one way, the . deadianother.
; The Cocopas
The Cocopa, who lived mainly along what is now the Arizona-Sonore border, practiced some agriculture, but depended largely on hunting and gathering. Theirs was a relatively simple dulture; they possessed few goods, they conducted few ceremonies. The whole tribe, in the late nineteenth century, consisted of some twelve hundred people, scattered in small settlements. People feom several settlements might come to- gether-for a harvest fiesta, but many more would gather for the °cob- sion of a mourning ceremony. The death ceremonies were the.prinoipal religious and social events of the tribe.
Soon after a death, the,mourning members of the family became transported into an ecstasy of violent grief behavior. They cried, wailed, and tcreamed from the timeof the death, without much inter- ruption, for twenty-four hours or more until the body was cremated. The cremation ritual* was directed mainly at inductinc the spirit of the dead person to go on to the afterworld. To help -persuade the spirit to depart, clothes, food, and equipment we.e destroyed so that the spirit could have these things in the hereafter.
Some time after the cremation, a Cocopa family would give a mourning ceremony to commemorate its dead. Then a large part of the tribe would gather, there would be speeches and lamentations for the dead. At all other times, the names of the dead could not be men- tioned; at this mourning ceremony dead relatiyes were recalled.publicr ly, summoned td mingle with the assembled tribesmen, and impersonated by.men and women dressed in ceremonial costumes tn resemble specific deceased persons. Presents were given to visitors, and valuable goods, N including a ceremonial house and the ceremonial costumes, were burned for the benefit of the spirits.
The Hopi
The Hopi are one of the Pueblo tribes of Arizona. They are agriculturalists and follow a highly ritualized complex way of life. Funeral rites are held in the old tradition which minimizes the whole event of death and funerals.
The Hopi do not like the idea of death ands they are afraid of the newly dead. Their funeral rites are small, private affairs, quickly over and best forgotten. Those who are bereaved may well feel the pain of loss as deeply as do mourners in any society, but they give
'3 4 29
themselves over to no overt transport of grief of the kind expected of mourners among the Cocopa, Kotas, and in many another society. The Hopi cherish the middle way; they seek to avoid excess'of any ktnd; their most desirable universe is .one in which all'is measured, deliberate, and under control. Weeping may be unavoidable, but it is not encouraged, for Any cause. If one must weep--Hopi parents have
* told their children--it is best to weep alone, outside the village, where no one 'can see.
As soon as a death'occdrs in a family, the women of the household do lament; they cry q bit and speak of their loss. But there is no formal wailing hor is there a public gathering. The body is quickly prepared for burial and put into its grave as soon as possible,. A woman relative washes the head; prayer feathers and a cdtton mask are put on the corpse; it is 'wrapped and carried off straightway by the men of the household.
As with the Kotas and many other peoples of the world, contact 'with death brings pollution. Before persons who are thus,polluted can resume normal relations with men and with the gods, they must divest themselves of the taint. Hence, on their return from the burying ground, the nembers of the household purify themselves ritually. The next morning a male relative of the deceased puts mlal and prayer sticks on.the new grave, prays for rain--a central good of Hopi life-- and asks the spirit not to return to the 011age. To ensure-the departure of the deceased, the relative symbolically.closes the trail back to the village by drawing.charcoal lines across it. When he comis-back to the beivaved household, all wash their hair and puripy ,themselves in pinon smoke. "They should then try to forget the deceased and continue with life as usual."
The spirit is believed to rise from the grave on the fourth morning and to follow the path to the land of the dead, somewhat in the general area of the Grand Canyon. It then becomes one of the great assembly of supernaturals. Withsthese the Hopi are greatly con- cerned. The supernatural spirits are continually invoked; they are frequently asked for blessings; they come to the villages on cere- monial ocasions. But the spirits are not Hopi; they are a different class of being and Hopi culture provides rules and means for dealing with them. The spirits are-depersonalized entities; they do not have , the characteristics of deceased friends and relatives. The Hopi go to great lengths to make sure that the dichotomy of quick and dead is sharp and clear. Many rites having to do with spirits conclude with a ritual device which breaks off contact between mortals and spirits.
411. 30
INFORMATION SHEET 3
Philosophies of Death
Since death js inevitable, it would appear that individuals or groups Will inevitably provide some meaning fordeath-related phenom- enn, since they will be forced, one way,gr another,to confront death. , Flow they confront death and the set of lifinitions which are developed in this confrontation evidence considerable variation. The meaning of death which'man has developed can be gróuped into two broad orienta- tions: a temporal, this-world orientation, and aspiritual or other- world orientation%
The temporal.orientation to death involves the following:
I. Rejection or de-emphasis, in one form or another, of definitions of an afterlife. Man is viewed as a mortal being, living in a empir- ical world. "From dust thou art and unto dust thou shalteturn" characterizes this type of orientation. Life and death are interpreted primarily in terms of their human or natural dim sions.
2. Belief in the finality of death. Death is seen as the end of the individual.
3. The concerns centered in death focus upon the conseqUencesfor the living--the bereaved or others.
The concerns of the individual,with his own death tend to concen- trate upon the present and the future. The future concern, how- everois for the future of the living, not of the dead or dying.
5. Tha concern with immortality is not necessarily absent fromsuch interpretations. Immortality is not defined in terms of the actual individual continuing indefinitely in some form orother, but rather on his influence, work, and projects be:4 continuedin the behavior and the culture of subsequent generations. Beliefs,, behavior patterns, and money may be transmitted from one genera- tion to another. The sins and blessings of the fathers may be visited upon the heads of their children feomtgeneration to gener.r. ation, not in any mystical, supernatural manner, but rather through the process of cultural transmission.This.interpretation is supported by the fact that members of i society areconstantly in- OP being replaced, a few at a time, while the society continues definitely. Society is more-than any one individual. It has an existence independent of the existence of any one individual. It 4 is a group.
* Vernon, G. The Sociology of Death.New York: Ronald Press, 1970, pp. 30-55. 36 31
The second orientation is called spiritual or otherworldly. A major characteristic of this'orientation is that attention isdirected away-from the natural or femporal aspects of dying to nonnatural or maybe supernatural dimensions. Interpretations which involve tfich nonempirical concepts are not capable of being validated orinYali- dated 'by the.scientific method, but are accepted by those whodo endorse them'as a matter of faith. A spiritual interpretation is characterized by the following:
1. Endorsement in one form or another of some type of afterlife or existence which continues beyond the physical or temporaldeath.
2. Rejection of the belief in the finality of death.
' 3. Concern with the temporal aspects of death coupled withand relat- ed to concerns with the spiritual aspect. Behavior may bo directed toward a living audience, but also toward a supernatural audience.
The futire-oriented concerns of maneXttnd beyond the grave*
5. Concernis with immortality of the individual as some typeof entity, with that concern being coupled to other concernsof a morettemporal nature. -
A combination of temporal and spiritual orientations is mostlike- ly woven into the meaning which most people have of death aswell as into most funeral behavior.
WO
3 Z 32
INFORMATION SHEET 4
BIBLIOGRAPHY
Alsop, Stewart. Stay of Execution: A Sort-of Memoir. Philadelphia: Lippincott, 197144
A popular journalist's reaction when he discovered thathe had leukemia and might soon die.
Aries, Philippe. Western Attitudes toward Death: From the Middle Ages to the Present. Baltimore: trohns Hopkins Press, 1974-.7
4 stimulating short Work which utilizes literatiwe, art, and other sources in order to chart changing attitudes toward death.
Becker, Ernest. The Denial okeath. New York: The Free Press, 1973.*
A fascinating and humane Pulitzer Prize winning work which argues that the fear of death is and has been acentral factor in determining human conduct.
Brown, Norman. Life A ainst Death. Middleton, Conn.: Wesleyan University Tress,.
Not an easy work to read but worth the effort. Brown argues that our fear of death and our desireofor immortality contribute td neurosis and unhappiness.
Choron, Jacques: Modern Man and Mortal i'tx. New York:, Macmillan, 1972.*
Concise and interesting coverage of concepts of death, death fears, and the.impltications of living. Remarkable in its wide
and.stimulating range of references and quotations. ,
De Beauvoir, Simone. A.Very Easy Death. New York: Warner Paperback
- .Library,.1973.*
An account of the dying process of this famous French writer's Mother, 4;ong with the daughter's reflections on death and dying.
.*
. Available in paperback.
'Available in cassette books.
38 33
Feifel, Herman, ed. The Meaning of Death. New York: McGraw, 1959.*
An excellent anthology of nineteen selections encompassing Teligious, literary, philosophic, artistic, psychologicali and medical approach to the subject.
Gatch, Milton McC. Death: Mtaning and Mortality in Christian Thought and Contemporary Culture. New York: Seabury, 1969.
A historical approach which stresses approaches from the early Greeks to the Reformatiim.,
Glaser, Barney and Strauss, Anselm.Awareness of Dying. Chicago: Aldine, 1968.-
These-two works deal with the.inieraction of families, hospital staff, and doctors with the dying.
Gordon, David. Overcoming the Feqr of Death. New York: Macmillan, 1970.*
Simply written, this work discusses soUrces of the fear ofdeath and offers a viewpoint for banishing this fear.
Grollman, Earl A., ed. Explaining Death to Children. Boston: Beacon, 1967.*
Ten selections from different perspectives, includingpsYchologi- cal, religious, and literary.
Hinton, John. Dying. New York: Penguin, 1967.*
A physician discusses the taboo relative to death and the -mmedical problems this causes, with recommendations for change. iamprehensible to the layman.
Kavanaugh, Robert. Facing Death. Freeport, N. Y.: Nash, 1973.*
Clearly written advice from a psychologist and former priest who . has experienced the deaths of several people who were close to him, including his father.
Kubler-Ross, Eljzabeth. On Death and Dying. New York: Macmillan, 1969.*
Simply and affectionately"written, discusses this psychiatrist's work with dying patients in terms of "stages" of the dying process and her approach of helping by learning from the dying person.
Kutscher, Austin H., ed. Death,and Bereavement. Springfield, Ill.: C. C. Thomas, 1969.
More than forty selections of all types, including some excellent literary treatment.
39 , !Afton, Robert Jay and Olson, Eric. Liyimancibfill. New York:
, Praeger, 1974.*
A short, brilliant re/Liable work. Lifton is a National Book Award winner for his Death in Life: Survivors of Hiroshima.
Magu0e, Daniel C. beath by Choice. Garden City, N. Y.: Doubleday, 1974.
A Catholic theologian examines the moral impliCations of euthanasia.
Mitford, Jetsica. The Americad Way. of Death. New York: ,Simon & Schuster, 1963.=
A stinging criticism of the American funeral business.
Solzhenitsyn, Alexander. Cancer Ward. New York: Farrar, Straus & Giroux, 1969.*
The celebrated Russian novel that deal with.life in the shadow of death.
Stannard, David, ed. Death in America. Philadelphia:. University of Pennsylvania Press, 197t.*
Eight essays by cultural historians, anthropologists,.literary scholars, and art historians.
Tolstoy, Leo. The Death of Ivan Ilyitch. Various editions.*
A 'superb ficti^nal account of a middle-aled man face to face with a fatal sickness.
Vernon, G. The Sociology o DeathNew York: Ronald, 1970.
A complete text covering meanings of death, bereavement,.and
disruptiOns of death upon social systems. It cites many studies . and provides good summaries. 35
SESSION.II
Customs Surrounding Death
Aim:
To help participants:
(1) Recognize the universal human need for symbolic rituals in dealing with death.
(2) Understand some Of the motives underlying.cultural practices surrounding death in the United States.
(3) Understand that the customs and rituals surrounding death reveal an individual's or society's philosophy aboutdeath.
(4) Become more open i, their willingness to discuss the topic . of death through the sharing of feelings with otherpartici- , pants.
Resources Needed:
Newsprint, felt markers, and masking tape Chalkboard, chalk, and eraser .Slides, "Funeral Customs Arouhd the WorW Slide projector, screen Cassette tape player Lined tablets, pencils List of questions on newsprint Information Sheet 5, "Stages of Death and Dying"
Room Arrangement:
The room should be arranged with .-vable chairs placed in a semi-circle. Yhe slide projector, cassette tape player, and screen should be set up and ready for use.
Teaching Plans for Session: (5 minutes)
A. Introduction: Listing of "Death Customs" Activity
The session and the first activity might be introducedin the following manner: 36
"Much of what we believe and do in life is remembered, symbolized, and honored in the ways we end life and bury the dead. This is true for people throughout the world. Burial practices are common to all human groups.A comparative study of these practices and customs will help us increase our understanding of our own customs and our own need to express our feelings and concerns through ritual.
"By looking at the ways in which diverse cultures dispose of th6 lead, we can learn much'about the goals and worth that life holds for those still living. In addition to what burial cu,toms tell us about what is important to those who are alive, a study of death Customs is important 6acause it is a subject of universal interest and, yet, most of us-know little about it. -By comparing various practices associated with death, we can better understand the values and reasons behind the events surrounding the end of the life cycle.1
"Let's beginbY'examiningsome of the customs practiced in the United States. In small groups try to list as many customs surrounding death in the United States as you can in five (5) minutes."
B. Listing of "Death Customs" Activity (20 minutes)
Divide the participants into discusiion groups of not more the six (6) members. Ask each group to select a recorder and a reporter. Have the assignment wiltten on newsprint.or chalkboard: "List as many customs surrounding death in the USA as you can in 5 minutes." Ask each 'group to list their customs on newsprint or chalkboard.
After the small group discussions, have each group, in turn, to report only one custom in order that each group will be able to make an input. Repeat the process until all the customs have been recorded. When the list is complete, tell the participints that "we wil1 come back to this list after 4. we have examined customs in other cultures, and we will try to draw some comparisons at that time."
C. Slides on "Funeral Customs Around the World':
Introduce the slides with remarks similar to these:
"You have read Information Sheet 2,'Death Ceremonies,' which was handed out at the last session of 4he workshop. We would now like to v.iew some slides on customs around the world.As you yiew the slides, keep in mind the following questions:
110 10Death a Part of Life," Center for Teaching International Rela- tions, University of Denver, Denver, Colorado, p.i, 1976.
42 37
1. Which cultures are most similar in.their customs? Which are most different?What explanations can you give for these similarities and differences?
2. What needs do people seem to have when a person dies?
3. What are the purposes of the ceremonies becFore the burial
Now or cremation of the body?
4. Why do customs that serve the same function differ in so many ways?
5. What do these custms anc rituals say about how persais view life and death?"
These questions should already'be on newsprint and should be referred to as they are shared with the group.
View the slides.
D. Discussion.of Slides (25 minUtes)
Using the same small groups selected in activity B, have the groups to respond to the five (5) questions given prior to the filmstrip. Assign one question to each small group. If there are fewer than five groups, several groups would deal with more than one question. Work in the small groups about 10 minutes and then come together in a total group for a time of reporting andVital group discussion of the ideas presented. The major idea should be recorded on newsprint or chalkbpard.
E. Concluding Activity (20 minutes)
Return to the l:st, "American Customs Surrounding Death," recorded in Activity B. Ask the total group to discuss the questions: "How do our American customs serve the same needs as those practiced by other cultures?What purposes do_they serve? What do our customs say about how we view life and death? Do any of our customs illustrate points of view similar to any of those found in Information Sheet 3, 'philosophies of Death?' If so, which ones?"
F. Handouts for Next Session (5 minutes)
Give pardcipants Information Sheet 5, "Stages of Death and Dying," and ask them to read it by next session.
_ G. Topic for Next Session
Tell the participants that the topic for next session will be "Stages of Death and Dying and Alternative Care."
43 38. eatb
a.
Taint of INFORMATION SHEET 5
The Stages of Deatharid Dying*
Dr.'Elizabeth Kubler-Ross has observed five matjor stages in the dying process. Her studies have found that these stages tend to occur in order but not always. Below are her five stages and a brief descrip-
tion of each. ,
I. Denial and Isolation - This stage is evideni when the persons becomes aware of his/her terminal illness and says, "No, not me." Periods of denial are uied positively as a healthy way to cope with the shock of finding out the,truth. This,also causes many people to seek other idvice about the seriousness of the illness. However, it is helpful for the patient to eventually reach a willingness to discuss the illness.
Anger- In this stage, the patjent often asks,"Why me?" He/she feels resentment and envy, frustration and helplessness. They are angry with family, doctors, nurses, and friends, and need to feel cared for and respected.
3. Bargaining - After the anger subsides, the person begins bargain- ing with God, the staff or the illness itself. The person.wants more time with-which to be cured or .to finish undone work. This stage is looked upon as a positive stage where the pe-son is not -\ giving up, rather fighting for what life is left.
4. Depression and Withdrawal -In this stage the person feels a great sense of loss either from past losses, disappointments ind guilt or from future,losses from family and material goods. Often the depression is not openly expressed, but should be allowed to proceed. Cheering up and supporting the person is very helpful during this stage. Dr. Kubler-Ross sees this stage --of depression as necessary and beneficial if the patient is die in a stage of acceptance.
5. Acceptance -In this final stage the person "contemplates the end with a certain degree of quiet expectation." The person is usually tired and weak, and is "resting before the long journey." It is a time when the person is more acceptant of death than family and friends.
Adapted from Elizabeth Kubler-Ross. On Death and Dying: New York: Macmillan, 1969.
4 4 39
SESSION III
Stages of Death and Dying. and Alternative Care
Aim:
To help participalts:
(1) Understand the various stages of the dying process and to . understand that these stages are experienced by most people.
(2) Become aware of various caregivers involved in the dying process.
(3) Reflect on how alternative care systems might help in the acceptance of death.
Resources Needed:
Filmstrip projector, cassette recorder, and screen Filmsttip and audiotapei "Toward an Acceptance" Newsprint, felt markers or chalkboard, chalk, and erasers_I
- Information Sheet 6, "Trigger Questions on the 'Stages orDeath and Dying'" 0
Room Arrangement:
The room should be arranged with movable chairs placed in a semi- circle: The slide.projector, cassette recorder, and screen should be . ready for viewing.
Teaching Plans for Sessions: (30 minutes)
A. Show the Filmstrip "Toward an Acceptance"
Introduce the filmstrip to the participants. The following statements might be used:
"In the last two sessions we have discussed our feelings about'life and death and have become aware of the inter- relatedness of these dominant themes. last session we specifically discussed the symbols and rituals of death and dying in various cultures, including our own. Perhaps we have came to a better understanding of how conceptionsof life and death are trarislated and made real through our culturally rich. traditions. Many of these traditions have go a profound effect on how we face death--forourselves, our friends, and loved ones. 45 40
"Death, as we all know, is not reserved.only for older adults. Rather, we are confronted with the possibility of V accident, disease or sudden death at any time in our lives. How we live with that possibility and react to its certainty have been the study of theologians, physicians, psycholo- gists, sociologists, poets, and many other professional people.
"In this session we will discusi'various stages that re- searchers have observed in terminally ill patients, and even those victims' of accidents or sudden illness. HOw we as human beings deal with such a reality is a viluable topic for discussion and reflection.
"We are going to view a filmstrip based on the research of. .Elizabeth Kubler-Ross, a Physician/Psychiatrist at the University of Chicago. Her research articles, books, movies, and T.V. appearances have reached. millions of people and have done much-to remove the-tabod nature ofthe study of death. Her major research has been focused on the major stages of death and dying. As you view the filmstrip, center your attention on these questions:
2 Wh:t Irsei=4:g7n ggeOrthedsgg 3 What is the role of individuals who care (caretakers) for the dying person at each stage?"
It . B. Small Group Discussion of Filmstrip (20 minutes)
Following the filmstrip, divide the participants into five small groups. Assign one of Kubler-Ross' stages of dying to each group as follows: (1. Denial and Isolation, 2. Anger, 3. Bargaining,'4. Depression and Withdrawal, 5. Acceptance.). Hand out Information Sheet 6, "'Trigger Questions' on the Stages of Death and Dying."
C. Total Group Discussion (30 minutes)
Return to the total group and have each small group to report its thoughts. Allow some time for total group discussion after each group reports. Quastions such as nese might guide the discussion:
How do you react to these thoughts? Are there other insights which come tn you regarding these ideas? 41"
D. Alternative Care Systems (20 minutes')
Continue in a total group discussion, but shift the group from its previous thoughts to the present topic by using words similar to these: 46 41
"We've been looking at the stages of death and dying And we've been looking at some of the needs the individual has at each stage. We've also given some thought as to the kind of roles caregivers need to fulfill at.each stage. Given this background, let's spend a few manents brainstorming about some alternative care systems which may more realis- tically take into account the stam of death and the particular needs of the individual at each stage. First of all, how can better care be provided for the dying person at each stage?"
Try to get the group to quickly list a number of ways that care can be provided. You might record these ideas on newsprint or chalkboard.r Do not spend much tint on each idea. Just get as many ideas as possible.
After a few minutes of brainstorming, ask the group to discuss these questions:
(1) In what ways do you think professional caregivers could' 'Income well-trained and more sensitive to the needs of dying persons? Can persons like us be trained and become more sensitive cat:egivers? Haw?
(2) Can same of the fears and anxieties of the death experience be lessened through the efforts of care- givers--both professional and lay persons? Why or why not?
E. Topic for Next Session
Tell the participants that the topic for the next session will be "Handling Grief." 42
INFORMATION SHEET 6
"Trigger Questions" on the Stages of Death and Dying
DENIAL AND ISOLATION 1. When do ,people become aware that they are dying? 2. What is the best way to inform the person? 3. 'Who is responsible for informing the person--the doctor, the family, a minister? .4. What clues are usually present in a terminal situation--pnysical dysfunction, visitors' emotions, demeanor of the staff? 5. How does conflict'betweeh the doctor's drive for life and the reality of death help or hinder the awareness process? 6. How is denial a protective device? 7. How does denial prolong ,the process of abceptance? 8. What caregiver roles are needeci by the dying person at this stage?
ANGER 1. How do the anger and resentment of becoming aware of death fit a normal' process of the death'experience? For young peoplelFor older people? 2. Oat are the conflicts between sudden illness versus long tOrminal decline? Is it fate or natural order? 3. Which caregivers are imiolved in helping the patient use this stage positively? 4. What caregiver roles are needed by the dying person at this stage?
BARGAINING 1. Does the struggle excited'by death awareness block suggestions for improvement or drive the patient to seek cures elsewhere? 2. Should the patient be given any alternative activities or life purposes which could possibly enhance positive feelings about the rest of one's life, e.g., travel, community involvement, creative outlets? 3. Do people believe that time cures all ills? 4. What caregiver roles are needed by the dying person at this stage?
DEPRESSION AND WITHDRAWAL 1. How can people be' supportive of a person who feels sad about e*, dying? 2. How can people avoid or overcome feelings of pity and grief to become a stronger, more sensitive friend to the dying? 3. How are nonverbal signals shared (nods, smiles, holding,Aands)? 4. What caregiver roles are needed by the dying person at this stage?
48 43
ACCEPTANCE I. What is the relationship between acceptance and one's philosophy of life? 2. 'Is acceptance related to satisfaction with life? 3, How does acceptance help the person go about preparing for death? 4. What are some ways of alleviating the fear of death? 5. What caregiver roles are needed by the dying person at this stage?
"h.
Air
49 44
SESSION IV :
Handling Grief
Aim:
To. help participants:
(1) Understand the meaning of grief.
(2) Understand the stages of grief.
(3) Examine their own feelings about grief.
(4) Become aware of roles that caregivers may assume with those in grief.
Resources Needed:
Tapeplayer Definition of grief on newsprint Newsprint and felt markers or chalkboard and chalk Information Sheet 7, %went" and audiotape Information Sheet 8, "Grief Work" Information Sheet 9, "How to Be.a Caregiver in a GriefSituation" InformationioSheet 10, "Prayer of St. Francis", andaudiotape Booklet "On Being Alone," published by AmericanAssociation of Retlred Persons Leaflet, "Bereavement--A Family Crisis"
Room Arrangement:
The room should be arranged with movable chairs placedin a semi- circle.
Teaching Plans for the Session:
A. "Lament" Tape (10.minutes)
Begin the session in some way similar to this:
"In our last session, we sprit some time looking at the stages of death and dying. These were the stages the dying person goes through, but therejsanother concern i the dying process which was not really dealtwith las ime. I am talking about the grief experienced bythose persons left behind. The healthy handling of grief is a real con- cern, and it's what we will bedealing with in this session. To start off our thinking about grief,I would like for us ( 1 4 45.
tO listen to a poem by Edna St. Vincent Millay entitled Lament. As you listen to this poem, try to sense what it means to grieve."
.Give the participants Information Sheet 7, "Lament," and play the tape.
AfteY.the tape, ask the participants to describe what grief is as they sensed it in this poem. Do not take a long time with these descriptions.Just quickly get a number of ideas from the group members.
B. Triads ,(15 minutes) '
Divide the participants into groups of three (3). Ask each .person to briefly tell their group some grief experience. they have experienced, and in one word try to describe how they felt. Take about 5 minutes in the triads ano then let the groups share their "one-word descriptions" witW the total group. Record these words on newsprint or chalk- board. Leave these words before the group for the duration of the session as a "mood-setter" or "conscious-raising experience."
C. Define "Grief" (10minUtes)
In an effort to come to some understanding of what is meant 0 by "grief," spend a few moments in getting the group members to express how they would define "grief." You could intro- duce this activity by saying:
"We have been describing what grief is like and how we feel, but how would you define 'grief7"
i/ Let several group members share tpreirunderstanding of grief, and then share this definition with the total group:
"Grief is the human reaction to loss, specifically the loss of someone by death. It is among the deepest pains experi- enced by a person."
Show the definition on newsprint. Ask the group, "How do you react to this definition? How would you change it?" Again, a large amount of time does not need to be spent on this .activity, The main purpose of this activity is to get the individuals to voice their ideas of what "grief" is and to come to some general understanding of what they .as a group mean when they speak of "grief."
D. Study of "Grief-Work" (30 minute )
* Introduce the next activity intjefollowing way: *
"Grief-work' is a term used first by Sigmund Freud in which he emphasized the need of completing the task ofmourning, to accept the reality of the death of a loved one,and to go through the'process,of cutting the emotional tieswith the dead person. It is hard work,.and usually takes consider- able time,..but on its completion a person becomesgradually . able.to seek fresh attachments in a free and uninhiblted manner. Otherwise the person carries unresolved grief which can show up in various illnesses inthe years to come. We want to spend a little time on seeing if we canunderstand how persons can works through grief in a healthyfashion. Get back intp your triads and spend about 30 minutes' discussing tbe questions at the'end Of Information Sheet8, "Grief Work."
E. Total Group Discussion (20 minutes)
Return to the total groupLanddiscussAhe ff.ur (4) questioni just discussed in the triads. Each triad does not have to "report."Ardk each of the following questions and let
various persons respond as they will. .
(1) HoW realistic do you feel the "Three Stages ofGrief" and/or the "Ten Stages of Good-Grief" are? Explain.
. (2), Does one have to go through-either the "Three Stages" 'ror "Ten Stages" to be healthy? Explkin. (3) Do you see the "Three Stages" and/or "Ten Stages" inthe Jewish Ritual of Mourning? Where? 'What's mIssing? e- (4) Can other persons (caregivers) help in the grieving process? Why or why not?
F. How to Be a Caregiver (20 minutes)
The discussion of question No. 4 will,be anatural "lead in" for the next'activity. Introduce this portion of the session by saying:
"We often feel inadequate in a grief cperience. We don't know what to do or we just can't seem to findwords to express how we feel or to bringcomfort to the bereaved. Let's examine a list of 'Aids for the Caregiver'."
Distribute Information Sheet 9, "How to Be a Caregiverin a Grief Situation."
Use these questions in the discussion:
ea (1) How realistic are these "aids"? (2) Should, any be omitted? Why? (3) What other "aids" should be added? Why? 47 ../
G. Prayei. of St. Francis
Hand dut Information Sheet 10, "Prayer of St. Francis." e. 'Close the session by playing the tape, "Prayer of St. Francis." Introduce the tape by sPying:
"There is a fa us prayer attributed to St. Francis of Assisi could very easily be the motto of a caregiver. Listen closely to his wards. You can follow the words on Information Sheet 10."
4 H6 Hand Odt Publication "On Being Alone
6This publication is provided to you by the American AssociatTon of Retired Persons hoping that it may bring comfort to you or to a friend."
I. Handout leaflet "Bereavement--A Family Crisis"
Topic for Next Session
Tell the partic!pants that the topic for the next sess'Ion will be "Choices About Life and Death."
0
p-
.40r .41
V
53 I.
INFORMATION SHEET 7
Lament
Listen, children: Your father is dead. From his old coats I'll make you little jackets, I'll make you little trousers From his old pants. There'll bein Llis pockets Things he used to put there, Keys-end pennies Covered With tobacco; Dan shall hive the pennies To Save in his bank; Anne shall have the keys To make a pretty noise with. Life must go on, Though lood men die; Anne, eat your breakfait; Dan, take your medicine; 'Life must lo on: I forget jtst why.
Edna St. Vincent Millay
411.
54 49 eatb the Fullirnent of
vie INFORMATION.SHEET 8
Grief-Work
The Three Stages of Grief
I. The Initial Stage of Grief: Shock, disbelief, numbness, daze, anguish, unreality
II. The Second Stage of Grief: Acute grief, suffering; erratic moods,, quilt, anger, anxiety, depression, withdrawal, irritability, restlessness, loneliness, sadness, pain, ambivalance, hallucinations, weeping, despair 0^ III. The Third Stage of Grief: Beginning Recovery. A slow returning to life, new creative activfty; new interests, satisfactions, ups and downs, regres- sions, finally recovery.
Many counselors believe that the grief process will take at least a year, for some more people more. The first stage usually lasts a few days, the second stage six months-o-r so, and third stage, an addittonal six months.
Granger Westberg's Ten Stages of Good Grief Stage One - We are in a state of shock. Stage Two - We express enotion. Stage Three - We feel depressed and very lonely. Stage Four - We may experience physical symptoms of distress. Stage Five - We may become panicky. Stage Six - We feel a sense of guilt about the loss. Stage Seven - We are filled with hostility and resentment. Stage Eight -* We are unable to return to usual activities. Stage Nine - Gradually hope comes through. Stage ren - We struggle to readjust to reality.
JEWISH RITUALS OF MOURNING
1. From the time of death until the funeral the survivors are left to themselves. All external matters are taken care of for them by othes--food is provided, the house is taken care of,\business is closed. One does not comfort them yet--they are considered to be in shock and should.be left to their grief.
2. The funeral is important. Psalms are read they say w.lat we want to say and can't, and they have a special gic anyhow. A eulogy is mandatory, with rare exceptions is a mourner's prayer'. 50
At the cemetery, the ritual is brief. After burial--which is completed while everyone is present, and usually with everyone participatingfamily and friends form parallel lines facIng in, and the mourners walk between the lines and people say the formula: "May God comfort you together with all the mourners of Zion and Jerusalem."
3. "Shiva" is observed. The word means "seven," but it rarely in- volves seven full days. During Shiva, the family remains at home, and friends come to visit. Ideally, they all sit together and talk. In practice, there is lots of food and, hy the end of the week, some gaiety.
4. "Shloshim" is observed. This means "thirty," and it lasts for a month after the death. Then the men go back to work, the children go back to school, the women go about their-various occupations. There are no social gatherings or parties, but all routines are carried on during this period.
5. For eleven months after the death, designated people (close rela- tives) go to the synagogue a stated number of times a week-and during the service say the Kaddish, the mourner's prayer.
6.. Each year after that, in perpetuity, on/ e anniversary of the death, the designated people go to the ..,nagogue and recite the Kaddish during services.
7. On stated oecasions during the year there is a Yizkor, a memorial service for all deceased, and the Kaddish is said by all the designated people.*
For a fuller exposition of the Jewish concepts of Dying and Mourning, see Elizabeth Kubler-Ross, Death, the Final Stage of Growth, Chapter 3, pp. 38-51.
quESTIONS
1. How realistic do you feel the "Three Stages of Grief" and/or the "Ten Stages of Good Grief" are? Explain.
2. Does one have to go through either the 'Three Stages" or "Ten Stages" to be healthy? Explain.
3. Do you see the "Three Stages" and/or "Ten Stages" in the Jewish Ritual of Mourning? Where? What's missing?
4. Can other persons (caregivers) help in the grieving process? Why or why not?
Copied. Morris, Sarah. Grief and How to Live with IL. New York: Grosset and Dunlap, 1972,
a 56 (
51
the f or "ft INFORMATION SHEET 9
How to Be a Caregiver in a Grief Situation
Blessed are they that mourn, for they shall be comforted. Matthew 5:4.
"For sorrow shared is sorrow diminished."
, "When i1eath destroys an important relationship, it isessential that
someone be found partially capable of replacing thatrelationship." . Joshus Liebman
Aids for the Caregiver
One very important step toward being a caregiver is yourattendance in this course and what you have learned and are learning.
1. Be informed; try to understand the grief process. 2. Be there; go to your friend or loved one. 3. Let the bereaved set the pace--to talk or to be quiet. 4. Learn to listen: creatively, nonjudgmentally, interestedly. Listen to what I am saying; that is all the comfort I askfrom you. (Job 21:1-2 TEC) a. Listen with the "third ear"--it brings comfort and healing b. Listen to angers arid hurts c. Listen to failures and alienations 5. Include the bereaved in your activities. 6. Be supportive in the ups and downs of the bereaved.
57 52
INFORMATION SHEET 10
"Prayer of Saint Francis"
LORD,
. Make me an instrument of your health: where ther9jis sickness, let me brineture, where there is injury,
aid; 'f* where there is suffering, ease; where there is sadness, comfort; where there is despair, hope; where there is death, acceptance and peace.
GRANT that I may not: so much seek to be justified, as to console;
to be obeyed, , as to understand; to be honored, as to love.... for it is in giving ourselves that we heal; it is in listening, that we comfort, and fn dying that we are ilorn to eternal life.
Copied from Kubler-Ross, E. Death, the Final Stage of Growth. Englewood Cliffs, N. J.: Prentice HilI, 075.
58 53 - t.
SESSION V
/Choices about Life and Death
Aim:
To help participants:
1 (1) Understand, their choices in determining how, when ahd. where they wish to spend their last days or years.
(2) Examine their oWn attitudes and feelings about euthanasia.
(3) gecome familiar with the. "Dying Person's Bill of Rights"
aud the "Liviog Will." .
, (4) Become familiar with the hospice movement and its developmert.
Resources Needledl:
Video tape "A Dose of Reality" Video player and monitor Information Sheet#11, "Case Study" Information Sheet 12, "The Dying Person's Bill of Rights" Information Sheet 13, "The Living Will7 Information Sheet 14, "Living to the Brid" Leaflet, "Hospice of North Carolina, Inc." Chalkboard or newsprint Leaflet, "Have You Made Your Will?"
Room Arrangement:
The room should be arranged with movable chairs placed in &semi- tircle. Video player and monitor should be set up and ready for use.
Teaching Plans for Session:
A. Introduction: Euthanasia (5 minutes)
The session may be introduced in the following manner:
"In this session we will examine the choices,we may or may not have regarding how, when and where we may wish to spend our last days or years.
"Many of us are familiar with the Karen Quinlan case. Karen was a 21-year-old girl from New Jersey whose parents requested 54
that the respirator be removed after she had spent six months oft the machine in .what her,doctors called a'persistent vege- tative state; 'so Xhat she could be allowed to die,'with grace and dignity.' The doctors denied their request, and a long legal battle finally ended in a decision to remove the machine. As of April 1979 she has been in a nursing hpme and existing without the use Of artificial devices. This case caused the American public to re-examine itsstand on
euthanasia. '
"The term euthanasia means 'a good death,' and is derived' from the Greek words 'eu' (good) and 'thantos' (death). The generallg accepted definition for aCtive euthanasia is pajn- lessly putting to death persons v66-FiTiE incurable, painful, or distresstng diseases or handicaps. It is sometimes called
'mercy killing,' and is illegal . Passive euthanasia means the doctor stops treafing the pati-eTII-FRE allows him/her to die, and this practice is legal. The Euthanasia Society advocates "that there is a right to die and recommends having voluntary, passive euthanasia. 'Voluntary' means it's done with the _patient s consent. Tapive' means the physician simpll-ttops treating the patient and allows him/her to die. To the Society, a good death is one without pain, lingering or medical heroics; one with dignity, lionesty,and compassion. 4 "The case of Karen Quinian.raised the del icate medical and legal issue of: whether in addition to the right to live there is, in certain circumstances, a right to die. There- fore, some questions which we.might explore are: (1) Do I have a choice in,k deciding when I will accept extraordinary
medical help? . (2) Can I decide where and how I will die?"
B.' Case Study (25 minutes)
Divide paiticipants into discussion groups of not more than six (6) /members. Ask each group to select a recorder and a reporter.
Hand out "Case Stddy" (Information Sheet 11). Ask partici- pants to read the case study and discuss the questions at the bottom of the sheet.
After the small group discussions ask the reporter for each group to report on conclusions reached by the group.
C."The Dying Person's Bill of Rights" (10 minutes)
Ask participants to re-assemble in larger group.
The Dying Person's Bill of Rights may be introduced as fol lows:
a 55
"at
qilecently a document was developed at a workshop on, 'The Terminally Ill Patient and the Helping Person' at Lansing, Michigan. The document is called 'The Dying Person's Bill of Rights.' It is not a legal document but it offers some guidance to families of the terminally ill."
Distribute copies of "The Dying Person's Bill of Rights" (Information Sheet 12) to participants. Ask participants to follow as leader reads "Bill of Rights" and keep the follow- ing questions in mind as they read:
(1) Do.you agree or disagree that dying persons should have
. these rights? (2) Which items would you omit or add to the list?Why?
Following the reading ask participants to respond to the two questions.
0. The Living Will(10 minutes)'
The living will may be introduced as follows:
"Another document called the 'Living Will' has been developed by the Euthanasia Society. This will provides a way for:allow- ing the individual to have his own wishes be considered as well as to provide legal protection for the doctors and nurses. It is also designed to avoid leaving su'vivors with a sense of gu'ilt. There is widespread and increasing acceptance of this idea, and this practice of: 'cuthanasia' by advance agreement of the family, patient, and doctor allows one to die in dignity and not be keRt 'alive' with extraordinary measures which prevent 'nature from taking its course.' It should be remembered that this is simply a.choice--one choice, and that this4 will may be revised, ignored, or accepted--It may be revoked at any time simply by verbally stating to the doctor that you have changed your mind--It is more a moral commit- ment than a legal document."
Hand out "Living Will" (Information Sheet 13) and ask participants to follow as leader reads "will."
Ask participants the following questions: Could the "Living Will" ease the trauma of a death in a family? How? Would this will be useful to you? Why? Why not?
E. The Hospice Movement (10 minutes)
The hospice movement may be introduced as follows:
"No discussion of conditions'.surrounding the death experience would be complete without some reference to the hospice move- ment. As a program, it is gaining great momentum throughout the country and certainly deserves our attention. 56
"The hospice movement may be a choicelghich makes the thought of euthanasia 'unnecessary. The word hospice means 'a commun- ity of sojourners along the way.' In the Middle AgLs, a hospice provided a resting place for weary travelers. Today, hospice care provides the same kind of comfort for one'who is near the end of life's journey, as well as support for the families preparing for the eventual death of a family member.
"Dr. Cicily Saunders' established the first hospice in London in the-late 1960s, and its success has provided theimpetus for the movement in the United States, where New Haven, Connecticut, is the location of the National organization. There are presently many hospice organizations in the United States in various stages of development. The North Carolina Hospice was formld in 1977, with,Winston-Salem established as the state headquarters.*
"The hospice philosophy is as follows: the philosophy of hospice care is not radically different from that which has always been espoused by conscientious physicians as the ideal for humane medical care of persons. But there is a differ- ence in emphasis: when cure of the disease in a particular person is no longer the'appropriate goal (because no longer possible), then care becomes the appropriate goal. Hospice has to do with inaTing a person to live(as distimt from- 'exist') until he dies. This is aliiiigiram of care that pays
serious attention to symptoms--that relieves pain . and supports the family system.**
"With this background, perhaps the video tape we are going to see will provide additional insight ihtocaregiving. This film portrays. a philosophy similar to that of the hospice."
As you view the video tape think about the following questions (write questions on board or newsprint):
(1) How did this experience meet the needs of the persons in the film?
(2) Does hospice provide a better way'of dying? Why or why not?
(3) Was the person's own wishes and her best welfare alheys maintained?
(4) What was the role of the caregivers?
F. Shim Video Tape: "AD4e of Reality" (15 minutes)
Hospice of North Carolina, Inc. ** Ibid. 62 57
G. Discussion (15 minutes)
Following the video tape ask small groups to re-assemble and select a new recorder and reporter. Ask each group.to discuss one of the four questions. Each small group should report back to the total group following discussion.
H. Small Group Reports.(10 minutes)
I. H;nd Out Information Sheet 14, "Living to the End," and the Leaflets, "Hospice of North Carolina, Inc." and "Have You Made Your Will?".
Ask participants to take home information sheets for further reading.
J. Topic for Next Session
Tell the participants-that the topic for the next session will be "Decisions in Life about Death."-
63 58
Z. 0.
INFORMATION SHEET 11
Case Study
Mrs. Smith is a seventy-six-year-old widow. One evening she was found collapsed in her bathroom. She was rushed by ambulance to the hospital. The emergency room doctor could not feel herpulse nor obtain her blood pressure. She _was in a deep coma.
The doctor immediately began mouth-to-mouthresuscitation and later a nurse continued with ahand-operated bag ventilator. The EKG. monitor showed only a rapid heart rate, and noevidence of a heart attack. A continuous intraveneous drip had beenstarted, containing the standard scientifically correct drugs. Soon a stronger heartbeat could be heard and a pulse could be felt. She still remained in a deep coma and did not react to strong stimuli.
Meanwhile, her daughter was callpd and toldof her mother's critical situation. She said: "Do everything you can."
As Mrs. Smith's breathing became labored, abreathing machine.was used to sustain breathing. In spite of these efforts:the coma deepened. An hour latera neurosurgeon decidedto take X-rays of the blood vessels to her br n and found that she hadsuffered a hemorrhage Jue to the rupture ofne of the blood vesselsof the brain. The surgeon then perfopd surgeryto stap the bleeding. The surgery was successful, but Mj1. Smith remained comatose. She was transferred to intensive care w ere she remained for 10 daysreceiving all the. support measures possible. By the end of this time., her comalightened slightly. She mdved when she felt pain. She then developed another abnormal rapid heart rhythm. Electrical shock was used and a normal heart beat was restored. ow,
After 10 days she was transferred to aregular hospital room, but further improvement was slow and limited. She would respond to simple questions but could not express herself. She could_not feed herself and was finally discharged to a nursing home4 weeks after arriving at the emergency. room.
Question: Do you feel comfortable with theefforts made to prolong Mrs. Smith's life? If so, why? If not, why not? 59 eatb of itgrt INFORMATION SHEET 12
The Dying Person's Bill of Rights
I have the right to be treated as a livifig human being untilI die.
I have the right to maintain a sense of hopefulness however changing
its focus may be. 4^4 4;7 have the right to be cared for by those who can maintaina sense of /
-hOpefulness, however changing this might be. )
I have the right to express my feelings and emotions about my approach- ing death in my own way.
I have the right to participate in decitions concerning my care.
I have the right to expect continuing medical and nursing attention even though "cure" goals must be changed to "comfoet" goals.
I have the right not to die alone.
I. have the right to tle free from pain.
I have the right to have my questions answered honestly.
I have the right not to be deceived.
I have the right to have help from and fpr my family in accepting my death.
I have the right to die in peace and dignity.
have the right to retain my individuality and not be judged for my decisions which may be contrary to beliefs of others.
I have the right to discuss and enlarge my religious and/or spiritual experiences, whatever these may mean to others.
I have the right to expect that the sanctiy of the human body will be respected after death.
I have the right to be cared for by caring, sensitive, knowledgeable people who will attempt to understand my needs and will be able to gain some satisfaction in helping me face my death.
This Bill of Rights was created at a workshop on "The Terminally Ill Patient and the Helping Person" in Lansing, Michigan, sponsored by the Southwestern Michigan Inservice Education Council and conducted by Amelia Barbus. 65 60
- INFOOATION SHEET 13
The Living Will
TO MY FAMILY, MY PHYSICIAN, MY LAWYER, MY CLERGYMAN TO ANY MEDICAL FACILITY IN WHOSE CABE I HAPPEN TO BE TO ANY INDIVIDUAL WHO MAY BECOME RESPONSIBLE FOR MY HEALTH, WELFARE OR AFFAIRS
Death is as much a reality as birth, growth, maturity and old age-- /it is the one certainty of life. If the time comes when I, can no longer take part in decisions for my ownfuture, let this state- inent stand as an ekpression of my wishes, while I am still of soundmind.
If the situation should arise in which there is no reasonable expectation of my recovery from physical or mental disability,I re- quest that I be allowed to die and not be kept alive by artificial means or "heroic measures." I do not fear death itself as much as the indignities of deterioration, dependence and hopeless pain. I there- fore ask that medication be mercifully administered to me to alleviate suffering eveh though this may hasten the moment of death.
This request is made after careful consideration. I hope you who care for me will feel morally bound to foll9wits mandate. I recognize that this appears to place a heavy re0onsibility upon you, butit is- with the intention of relieving you of such responsibility andof placing it upon myself in accordance with my strong convictions that this statement is mad,.
Signed
Date
Witness
Witness
Copies of this request have been given to
For additional information contact:' Euthanasia Education Fund 250 West 57th St. New York, New York 66 61
INFORMATION SHEET IA
"Living to the End"
By John Knoble
Some Connecticut Yankees have importedfrom -England a reVolution- ary medical Concept thatpromises liberation from one of humanity's oldest fears--the drug-deadened, death-in-lifelong considered inevit- able for the patient with a chronic degenerativedisease. Known as the hospice movement, it makes the thought ofeuthanasia unnecessary.
The hospice movement (the word '.'hospice" means acommunity of so- journers along the way) says the time has comefor medical science to apply its wisdom to the task of,juilling peoplewho Lan't get well,die comfortably and meaningfulbto.- It seeks to do this.by establishing specialized terminal-care facilities where patients maylive until they die. Over 50 groups have been formed in theU.S.A.
Interest in the concept was sparked in 1969vhen the Rev. Edward F. Dobihal Jr., director of the Department of Religious Ministriesat Yale-New Haven Hospital, spent several months asvisiting chaplain at St. Christopher's Hospice.in nertheast London,founded in 1949 by Dr. Cicely Saunders.
Chaplain Dobihal had seen countless people gothrough the dying process in the hectic atmosphere of a generalhospital and he was impressed with the difference at St. Christopher's. He began to talk with his Yale Medical School and School ofNursing associates. A group visited St. Chrittopher's and was impressed.
A young expert in pain control, Dr.Sylvia Lack, came to New Haven in 1,973 to initiate the Home CareProgram. She had worked for two years in a joint appointment atSt.\Joseph's Hospice and St. Christopher's.,In her work she uses combinations of drugsinstead of just one, with excellent results, and stressesthat "non-narcotic drugs can be used for a long time effectivelyywhenpsychological factors affecting the patient are positive."
Financed by the National Cancer Institute, Hospice,Inc. has completed the second full year of its Home CareProgram. Now, founda- tions and individuals have contributed to thegoal of building a $3.1 million, 44-bed inpatient facility in Branford,Conn. A $1.5 million
Reprinted by permission from Modern Maturit ,AuguSt-September 1977, pp. 63-64. 67 62
4
Fedel appropriation wai approvedby the House Subcommittee onLabor and 4 lth, Edecation and Welfare this May. A National Advisory CouncJil headed by Elisabeth Kubler-Ross (author of the best-selling "On Ieath and Dying") includes more than 50 physicians and nurses,all reco nized acruss the couhtry fortheir expertise in terminal care.
The Branford inpatient facility was inspired by what has been done in hospices in England. It is designed by a group of New Haven conceed citizens, including doctors and nurses, as a model for America hospices. The group has already shown.how well the concept works in,the Home Care Program. Money for the facility is being sought from small *as well as large contributors; it is for everyone.
Only6a score of'American general hospitals now have terminal- care departments that provide medical resourcesfor comfort beyond the scope of nursing homes or convalescenthospitals.
To'date, the Home Care Program has served some several hundred terminal patients and their families. In one recent 12-monthmlod, 50 out of 170 patients died; of these, 17--23 percent morethan the national average percentage-v.-died at home. Although the numberare too few to make a statistical point, hospice peopleconsider tills a direct experience confixmatiowof similar percentages over the years in English hospices. And the figures provide grounds for their own confidence that hospice-type home care.will enable many rurepeople to have this universal wish granted.
Drugs are administered orally before the onset of pain. The pro- . NO cedures are used that have: been fo' nd effective inEngland. "No one ot, ever has to cry out forrelief," CHaplain Dobihal promises.
A hospice report also showed that those who did die in ahospital had been able to stay home an average of approximately twoweeks, longer, before entering.
The')Oughterof one patient wro'9: "My mother, ill with cancer, . wished to stay at home with her family. I needed help. Her physician recommended hospice. It was very reassuring to know that we could get help at any time, day or night. They always came to the house daily. In fact, they dffered to come and stay with mother allnight so could get some sleep. At the time nf her death they were here with us. It's been two months since her death, and they arestill in touch with us."
By means of a sophisticated combinationcif anti-emetics, individ- ual formulas are found for.each patient for control of nausea, sothat patients have an appetite for eating. "A simple meal is a pdwerful symbol of life," Nurse Charlotte Gray of the YaleSchool of Nursing says.
Hospice people do not like the term often applied to hospices--"a beadtiful place to die." The focus, they insist, is on life. "Most patients will be able to engage in meaninbful conversationright up to 'the .day of taking leave," is a familiar prediction byhospice enthu- siasts. In the new building, children will be welcome visitors. 63
Not long ago, my wife and I decided to see St.Christopher's for ourselves. We found a building more like a.vacation lodgethan a hospital. "Ministering to the whole person is so important in pain control," Dr. Saunders says. "And that has many facets. It starts with the.morale of the staff and the volunteers who gointo the com- munity. It includes relations with the patient's primaryphysician." She mentions how spiritual well-being is furtheredby the help of clergy, psychulogists, and other professionals, as well as by the constant evidence *that those who surround thepatient care.
Nurse Barbara McNulty of St. Christopher's told us: "Six patients who rece.tly came into residence have been releasedto their homes. We have actually found that there is a good chance in many casesthat our:methods may prolong life.
The Branford Hospice will copy St. Christopher'sprovision for a nursery for children of 'staff members,"so they won't have to worry about their youngsterz, 'Ind so the sound ofchildren's feet and voices will witness to life."
Dr. Saunders, however, insists that St.Christopher's should not be thought of as a model for Branford's Hospice. "You in America have your own distinctive genius," she says.
Lo-Yi Chan, the architect of Branford'sHospice, talks about the facility: "Color, furnishings, and space will,convey theimpression that this is a pleasant place to be. Whether in a. wheelchair or a bed, the patient will be mobile. In good weather, patients' beds can be moved into a garden."
While technical support systems will be at-aminimum as compared to a general hospital, palliative X-ray,pharmac3, diagnostic radiol-. ogy, oxygen, and suction systemswill still be used as needed, with a back-up arrangement for quick transportation to ageneral hospital if other supports are prescribed.
"The Hospice will look like a part of life,"'Chan says. 4Windows make it possible for a world outside to come inside. The setti.g must invite a nurse to sit on a bed with a patient, maybehold a hand or shed a sympathetic tear. There will be places for serenity, for when one comes to visit.one's father he mayfind something to say if the ..00m is designed so they are trulyalone."
The cost of care in the residential facility will be morethan most nursing homes, but considerably less than in ageneral hospital; it is estimated at 50 percent less. The fact that the Hospice Program of Home Care reduces the number of days necessaryfor hospitalization makes for additional saving.
As the hospice movement grows, more and more bedswill be freed in acute-disease hospitals throughout the countryfor care of patients who can possibly recover. 64
Chaplain Dobihal'iays: "In the hospice program, patients, family and staff share in the care-giving process. Patients provide other patients with inspiration and encouragement, g.;'ing them a senseof service when they might otherwise feel they are Jf nofurther use to anyone.
"They enable us to surmount the denial of death we have been taught--denial that has allowed us to tolerate the inhuman vegetation that is the hallmark of superfluousnessamong the terminally ill in America. But there are no superfluous people, and the extentto which we can humanize the process of dying--hy consecrating_death as a part of life--is a measure of our ability to humanize the processof liviug.
z
1* 1).
65
6 SESSION VI
Decisions in Life about Death
Aim:
To help participants:*
(1) Become more aware of many o the details involved in the dying process: estate planning, funeral arrangements and famiTy affairs.
(2).Understand'that through a fulfillment of life, death cLn become a fulfilling experience.
(3) Reach a clOsure between their past and present.feelings about death and facilitate plans for the future.
Resources Needed:
Nedsprint,'felt markers and masking tape Information Sheet 15, ."Some Practical llints about Death Arrange- ments" Pencils Information Sheet. 16, "Quotations about Death"
, Package of posttest questionnaires Booklet, "A Manual of Death Education"
Room Arrangement:
. The room should be arranged with movable chairs placee n a semi- circle.
Teaching_Plans for Session:
A. Introduction tothel:liscussion of Death Arrangrents (45 minutes)
This final session and the first activity might be introduced in the following manner:
"In the five revious sessions we have explored our feelings about death--cultural influences on American views of dying, the stages of dying, the process of grief, and the choices many individuals have about how they will die. In'this final session, we will focus on other kinds of important choices people make throughout their lives. A source for much anxiety and uneasiness about death is the whole notion of 66
death arrangements. How well have Itaken care of my financial'obligations? Have I provided well for my family? What kind of funeral arrangements do I want? How can I ease the burden on my survivors?These questions and many others are important problemsin the death experience, and we are going to try ,and answer some bf them as well asexplore others of concern to you."
.Divide the participants into groups of not more thansix 4 persons. Have half of the groups to list as manypractical and le*gal activities as possible thatshould be taken care of when planning one's estate. Ask them to'put their lists on newsprint. Have the other half of the groups to list as many activities as possible thatshould be taken care of when planning one's funeral.Ask them to place their lists on newsOints.
*After 10 minutes, have the groups to place theirlists side by side before the total group. Have the lists relating to estate planning placed together and havethe lists relating to funerals together. Starting with the estate lists,l)egin reading and mark out the duplications betweenthe lists, and compile one final list of things to be taken careof when planning Fe's estate. Use the same process to compile a list of activities related to planning one'sfuneral.
Hand out Information Sheet 15 and ask the groupto compare the handout with the compiled lists for anysimilarities and differences between the groups. Looking at the compiled lists, suggest 4-o the participant§ thatthe9 add any addi- tional items to Information Sheet 15 that are notalready listed there. This will give participants a list they can take home with them.
B. Discussion of "QuotatIons about Death"(30 minutes)
InVoduce the discussion in a manner similar to thefollowing:
"In this last experience we ha).e identified manyimportant and practical consi6erations in the deathexperienae. Now as we approach the end of thisworkshop, it is important that we attempt to bring all ourideas together, examine what it all means,/and instill in ourselves a futureof action and creativity in oeder to better m-et the demandsof a ful-
,/ filled life.
"Read along with me as I read from excerptsby various authors, poets and philosophers as theydiscuss their feel- ings about death and hopes for the future. As I read these think about how these ideas relate to you and yourlife."
Hand out Information Shec:t 16, "Quotationsabout Death," and read the quotations. 4
At the conclusion of the reading,ask the group to discuss the meaning of these quotations. The following questions might be used as a guide:
presented by these 1. What ideas about life and death are authors? Do you agree with theirthoughts? Disagree? ow would you changetheir ideas?
Whico of these ideas are mostmeaningful to you? Why?
3. How important is a sense offulfillment or meaningful- ness in.life to how weapproach death? Explain.
C. 'Complete Postests (15minutes)
In order to measure theeffectiveness of this workshop, my colleagues and I are asking you now tocomplete the same questionnaire that you completed six weeks ago. Please put your telephone number ofsocial security number just as you 'did before so that we can keep your twotests together. Remember that there will be no attempt'toIdentify persons with'their answers. We only want to be able tokeep an individual's responses together. Thanks for your help in this.
D. Hando0. booklet, "A Manual ofDeath Education"
E. Closing Discussion (10minutes)
In the lhst few m,nutes ofthismorkshop, and in an effort to bring closure to thesessibn, ask the participants for any commer.ts or questions heymight have about the whole work- shop experience. Ask them what they see as thespecific strengths and weaknesses of the workshop. Leader should record these ideas on newsprint orchalkboard. At the con- clusion of this experience, the workshopwill" be over. ./ -
e 68 a eatb the of /. INFORMATION SHEET 15
Some Practical Hints about Death Arrangements*
You should,know or da the following:
1. Know the state laws on estate planning. 2. Have legal will prepared. 3. Have your attorney, insurance person, or minister keep a copy of the original will. These people will have quick access to your will and prevent unnecessary confusion. 4. Know where the deed to your cemetery lot is. 5. Know where your marriage licenses and birth certificates are.
6. Know your social security number. ) 7. Have a copy of previous year's,tax returns. 8. Prepare complete biography. 9. Prepare list of close friends and family with addresses and
telephone numbers. . s 10. Prepare list of your doctors and dentists in order to avoid confusion. . 11. Prepare a list of your charity preferences. 12. Have safety 'deposit box in two names for easy access to the box. 13. Make your wishes known for the disposal of your body: science or burial. 14. Talk to and resolve with your spouse and family about funeral arrangemenis: a. Choice of funeral home b. Choice of funeral service, casket or cremation 4, c. Choice of minister or officiating person
Y411 should not do the following:
1. Keep the original will in a safety deposit box in only your name. 2. Fail to make.plans for your estate and funeral.
;.
Compiled from participants' suggestions in class on "Death and Dying" taught at Guilford Technical Institute, Fall 1977.
74 69
INFORMATION SHEET 16 .
Quotations on Death
Fear in'any form is essentially a thought. If we can eliminate the thought I fear death, then we can perhapsdissipate the fear of death itself.
The mainspring of human,behavior is the attainmentof "peak experi- ences" in which man _is unified with'himself, with othersand with the world; and death is the ultimate unification expetience--theculmina- tion and fulfillment of life.--Gordon.
There is only one event in our life and in our universe that really counts, and this is death.--Maeterinck
Life is real, lif t? is earnest, and the graveis not its goal, Dust thou art to dust returnest, was not spokenof the,soul. --Longfellow
The touching image of death Presents no horror to the wise And does not appear as the end To the devout believer. The former it forces back into l-ife
And teaches him to act; ( The latter is strengthened in the dark hour By hope of future salvation; For both, death becomes life. --Goethe
The summer's flower is to the summer sweet, Though to itself, it only live and die. --Shakespeare
No being can fall alyrt.into nothingness, theeternal is constantly astir in everything.--GoEhe
Oh death, the loveliness that is in theecould the world know, the world would cease to be.--Btladley
As to death--to be exact--the true goal uf life,I familiarized myself during the last couple of years to such an extentwith this true and best friend of man, that itsimage contains nothing terrify- ing but on the contrary, much which is pleasingand consoling.tozart 70
Like a day well spent bestows pleasant sleep So a life well used bestows pleasant death. --da Vinci
Death, like birth, is a secret of nature.--Marcus Aurelius, Meditatys
God made no death; neither hath he pleasure in the destruction of the living.--Apocrypha: Wisdom of Solomon'
Death is the date cif life.--St. Bernard, Sermon
Death, kind Nature's signal of retreat.--Samuel Johhson, The Valley of Human Wishes
Death's but a path that must be trod, If man would ever pass to God. --Thomas Parnell, A Night-Piece on Death
Death is but a crossing of the world, as friends do the seas; they live in one another Penn, Fruits of Solitude
Deathis but a name, a date, A milestone by the stormy road, Where you may lay aside your load And bow your face and rest and wait, Defying fear, defying fate. --Joaquin Miller, A Song of Creation
When death comes to me it will find me busy unless I am asleep. IfI thought I was going to die tomorrow, I should nevertheless plaat a tree today.--Stephen Girard
Death remains the one citadel of mystery which autonomous man is compelled to surrender to his God.--Theodore O. Wedel, Christianity of Main Street
When Michelangelo, already'well along in years, was discussing life with an old friend, the latter commented, "Yes, after such a good life, it's hard to look death in the eye." "Not at all!" contradicted Michelangelo. "Since life was such a pleasure,death,coming from the same great Source, cannot displease uS." --Tremmler Werke publication, Germany
There is little to fear in dying and nothing to fear in death. The best thing to do about death is to do all you can to avoid.it. Then forget it.--John Dollard, Victory Over Fear
A skeptical writer said some years ago that we ought not be trouble: about death. In our unwillingness to die, he said, we were no better than a lot of peevish children, who,having played outdoors all day, were unwilling to come in at 'eventide. You might hasten to add that children are called in at the close of day with a purpose. A. cnrdon Nasby, "The House Not Made With Hands," The Expositor 7 6 71
Arthur Brisbane once pictured a crowd ofgriteving caterpillrs carrying the corpse of a cocoon to its final resting place. The poor, distressed caterpillars, clad in black raiment, were weeping, and all and . the while the beautiful butterfly fluttered happily above the muck mire of earth, forever freed from its earthly shell. Needless to say, Brisbane had the average orthodox funeral in mind and sought to convey the idea that when our loved ones passit ls foolish to remember only the cocoon arld con6entrate our attention on the remains, while forgetting thebright butterfly.--Edmund K. Goldsborough, Sanctuary Magazine
Two children were overheard talking about the death of.their grandmother. The five..year-old girl was asking her seven-year-old brother how "grandmother went to God." "Well," said the boy, "it happened this way. First Grandmother reached up and up and up as far as she could. Then God reached down and down and down. When their hands touched, he took her."--Gene E. Bartlett, ChristianCentury
-/ 72
1
SuppleMentary Materials for Use with the
Iducational Intervention Module
on Death and Dyin9
4
4. 73
Filmstrips and Cassettes Available From Cost
"Walk in the World for Guidance Associates $64.50 me," filmstrip of a 757 Third Avenue three-part series; New York, New York 10017 "DeIth and Dying; Closing the Circle," (3 filmstrips; 3 cassettes/ 61-102-549)
"Funeral Customs Around Educational Perspectives Assoc. 33.00 the World," Series SF P. 0. Box 213 1972 - slides; cross Dekalb, Illinois,60115 cultural aspects of death and dying
"Perspectives on Death," Sunburst Communication 59.00 2 cassettes, 2 film- Suite 23 strips 41 Washington Ave. (1) Toward an Pleasantville, New York 10570 Acceptance (2) The Right to Die
P' Video Tape
vA Dose of Reality," Audio VisuAl Services 15.00 CBS - 60 Minutes Pennsylvania State University (rental) Production Special Seriices Bldg. University Park, Pennsylvania 16802 (814) 865-6314
Audio-Visual
Recordings 'Mortality" composed Folk Legacy Records, Inc. 5,95 by Daniel Reed Sharpn, Connecticut 06069 Album: The New Golden Ring, "Five Day. Singing,"-Vol. 2
"Ain't No Grave Can Folk Legacy Records, Inc. 5.95 1 Hold My Body Down" Sharon, Connecticut 06C59 Albr: Drive Dull Care, Away, Vol. 1, Joe Hickerson
71J\ 74
Audio-Visual (continued) Available From Cost
"0 Death, Where Is Thy Birdwing Records $ 9.98 Stjng?" A Div. of Sparrow Records, Inc. (purehase) From: "The Messiah" by 8187 Cahoga Ave. G..F. Handel by LondonCanoga RR, California 91304 Symphony Orchestra and
Chorus ,
"Bury Me Not on the Lone Radio Shacks Inc. 3.99 Prairie"sung by Hedy Tandy Corporation (purchas West Bcx 1J52 Album: Forty,Great Folk Fort Worth, Texas 76102 Songi> 500 One Tandy Center
"And When I Die" Columbia Records 5.97 Album: Grt. Hits/Blood, 51 W. 52 St. (purchase) New York, NeW York 4 Sweat and Tears
Booklets and Leaflets
"On Being Alone" NRTA/AARP 1909 K St.; N.W. Washington, D. C. 20049
"Hospice of NC, Inc." P. Box 11452 Oat Winston Sa1emNC 27106 (919)724-7122"
"Hav2 You Made Your Agricultural Extension Service .15 ea. Will?" Ricks Hall (purchase) North Carolina State University Raleigh, North Carolina 27607
"Planning for Funeral Agricultural Extension Service .15 ea. Cost" (Series.HE 221) Ricks Hall (purchase) North Carolina State University Raleigh, North Carolina 27607
"A Manual of Death The Celo\Press 2.00 ea.
Education" (1977) . Burnsville, North Carolina 28714 (purchase)
"The Living Will" Euthanasia Education Fund 250 West 57th Street
New York, New York . a "Bereavement--A Family Agricultural Extension Service .15 ea. Crisis" Ricks Hall (purchase) korth Carolina State University Raleigh, North Carolina 27607